| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,113 |
1,106 |
$12K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
745 |
740 |
$6K |
| V2020 |
Frames, purchases |
1,292 |
1,268 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
480 |
282 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
734 |
409 |
$2K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
32 |
32 |
$800.00 |
| 92015 |
Determination of refractive state |
374 |
374 |
$519.20 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
19 |
12 |
$104.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
268 |
140 |
$0.00 |
| V2599 |
Contact lens, other type |
29 |
29 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
39 |
39 |
$0.00 |
| 3072F |
|
38 |
38 |
$0.00 |