| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
236 |
234 |
$16K |
| V2020 |
Frames, purchases |
477 |
459 |
$13K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
43 |
43 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
164 |
162 |
$5K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
37 |
29 |
$3K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12 |
12 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
29 |
26 |
$1K |
| 92015 |
Determination of refractive state |
13 |
13 |
$0.00 |
| V2799 |
Vision item or service, miscellaneous |
13 |
13 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
81 |
81 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
16 |
13 |
$0.00 |