| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
673 |
673 |
$87K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
744 |
744 |
$82K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,967 |
1,966 |
$60K |
| 92015 |
Determination of refractive state |
2,812 |
2,812 |
$50K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,164 |
1,162 |
$28K |
| V2020 |
Frames, purchases |
2,049 |
2,048 |
$21K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
238 |
238 |
$17K |
| 92002 |
|
13 |
13 |
$858.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
37 |
37 |
$683.55 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,027 |
2,025 |
$0.00 |