| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
343 |
314 |
$15K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
112 |
111 |
$5K |
| 92015 |
Determination of refractive state |
211 |
184 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
123 |
95 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
66 |
65 |
$3K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
28 |
28 |
$1K |
| V2025 |
Deluxe frame |
12 |
12 |
$160.80 |