| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
113 |
113 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
54 |
54 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
69 |
69 |
$3K |
| V2020 |
Frames, purchases |
101 |
101 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
39 |
39 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
34 |
34 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
15 |
14 |
$950.00 |
| V2750 |
Anti-reflective coating, per lens |
12 |
12 |
$0.00 |