| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
254 |
203 |
$11K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
172 |
132 |
$8K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
25 |
15 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
75 |
64 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
119 |
118 |
$4K |
| 92015 |
Determination of refractive state |
159 |
156 |
$3K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
47 |
47 |
$2K |
| V2025 |
Deluxe frame |
114 |
78 |
$2K |
| V2020 |
Frames, purchases |
50 |
39 |
$653.60 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
12 |
12 |
$540.00 |
| V2750 |
Anti-reflective coating, per lens |
43 |
32 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
20 |
16 |
$0.00 |