| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
275 |
262 |
$17K |
| V2020 |
Frames, purchases |
479 |
421 |
$11K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
141 |
112 |
$10K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
59 |
59 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
40 |
24 |
$622.48 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
47 |
27 |
$489.33 |
| 92015 |
Determination of refractive state |
613 |
573 |
$0.00 |