| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
528 |
514 |
$23K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
649 |
317 |
$13K |
| V2020 |
Frames, purchases |
973 |
952 |
$11K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
27 |
27 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
50 |
25 |
$1K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
25 |
25 |
$1K |
| 92250 |
|
12 |
12 |
$534.00 |
| 92015 |
Determination of refractive state |
399 |
392 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,761 |
849 |
$0.00 |