| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
266 |
266 |
$15K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
289 |
286 |
$11K |
| 92015 |
Determination of refractive state |
233 |
233 |
$5K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
51 |
51 |
$4K |
| V2020 |
Frames, purchases |
177 |
149 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
42 |
35 |
$675.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
50 |
46 |
$410.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
43 |
43 |
$300.72 |