| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,325 |
1,323 |
$53K |
| V2020 |
Frames, purchases |
1,570 |
1,566 |
$33K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
812 |
804 |
$29K |
| 92015 |
Determination of refractive state |
2,410 |
2,404 |
$21K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
977 |
977 |
$21K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
142 |
141 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
49 |
49 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
12 |
12 |
$298.20 |