| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,777 |
1,768 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
137 |
137 |
$717.80 |
| 92015 |
Determination of refractive state |
781 |
776 |
$105.60 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
640 |
309 |
$51.30 |
| V2020 |
Frames, purchases |
1,543 |
1,423 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
16 |
16 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
678 |
310 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
30 |
15 |
$0.00 |