| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
285 |
232 |
$17K |
| V2020 |
Frames, purchases |
218 |
163 |
$2K |
| 92015 |
Determination of refractive state |
216 |
164 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
59 |
45 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
15 |
14 |
$1K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
14 |
14 |
$640.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
18 |
12 |
$0.00 |