| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
378 |
363 |
$22K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
41 |
37 |
$3K |
| V2020 |
Frames, purchases |
46 |
40 |
$916.80 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
32 |
26 |
$899.25 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
30 |
24 |
$646.80 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
19 |
13 |
$539.62 |
| 92015 |
Determination of refractive state |
25 |
25 |
$119.48 |