| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
369 |
351 |
$28K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
645 |
611 |
$25K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
523 |
511 |
$18K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
120 |
113 |
$10K |
| V2020 |
Frames, purchases |
729 |
706 |
$10K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
217 |
205 |
$9K |
| 92015 |
Determination of refractive state |
587 |
548 |
$7K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
104 |
91 |
$6K |
| 3072F |
|
681 |
644 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
355 |
347 |
$6K |
| S8301 |
Infection control supplies, not otherwise specified |
58 |
57 |
$434.00 |
| V2025 |
Deluxe frame |
15 |
15 |
$322.86 |
| 92250 |
|
15 |
13 |
$234.47 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
12 |
12 |
$221.66 |