| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,291 |
1,275 |
$125K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
474 |
468 |
$56K |
| 92015 |
Determination of refractive state |
2,310 |
2,266 |
$34K |
| V2020 |
Frames, purchases |
1,010 |
948 |
$16K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
294 |
276 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
142 |
133 |
$3K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
16 |
16 |
$739.27 |