| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
2,532 |
2,431 |
$132K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
2,500 |
2,432 |
$125K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,750 |
1,748 |
$85K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,662 |
1,659 |
$80K |
| 92015 |
Determination of refractive state |
132 |
130 |
$2K |
| V2020 |
Frames, purchases |
47 |
47 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
30 |
30 |
$502.70 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$381.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
31 |
31 |
$143.00 |
| 92025 |
|
14 |
14 |
$0.00 |
| V2799 |
Vision item or service, miscellaneous |
12 |
12 |
$0.00 |
| 3072F |
|
38 |
38 |
$0.00 |