| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
494 |
494 |
$45K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
253 |
253 |
$32K |
| 92015 |
Determination of refractive state |
666 |
663 |
$12K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
342 |
341 |
$10K |
| V2020 |
Frames, purchases |
314 |
311 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
81 |
81 |
$2K |
| 92060 |
|
40 |
40 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$334.80 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
316 |
316 |
$0.00 |
| 1036F |
|
15 |
15 |
$0.00 |
| G9903 |
Patient screened for tobacco use and identified as a tobacco non-user |
13 |
13 |
$0.00 |