| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
737 |
734 |
$11K |
| V2020 |
Frames, purchases |
1,517 |
1,508 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,686 |
1,213 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
535 |
346 |
$2K |
| 92015 |
Determination of refractive state |
45 |
45 |
$162.80 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
32 |
32 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
54 |
27 |
$0.00 |