| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
143 |
131 |
$10K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
117 |
111 |
$9K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
83 |
77 |
$412.44 |
| 92015 |
Determination of refractive state |
296 |
279 |
$38.79 |
| V2020 |
Frames, purchases |
234 |
222 |
$0.77 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
25 |
25 |
$0.77 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
198 |
186 |
$0.00 |