| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
364 |
332 |
$29K |
| V2020 |
Frames, purchases |
766 |
715 |
$19K |
| 92015 |
Determination of refractive state |
837 |
790 |
$11K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
536 |
514 |
$10K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
94 |
93 |
$6K |
| 92083 |
|
115 |
108 |
$5K |
| 92250 |
|
81 |
78 |
$4K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
77 |
73 |
$4K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
90 |
89 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
28 |
27 |
$3K |
| 92133 |
|
31 |
31 |
$1K |
| V2750 |
Anti-reflective coating, per lens |
16 |
12 |
$301.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
95 |
89 |
$39.00 |