| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,382 |
1,353 |
$125K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,208 |
1,196 |
$56K |
| 92002 |
|
493 |
493 |
$27K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
362 |
346 |
$22K |
| V2020 |
Frames, purchases |
323 |
300 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
42 |
32 |
$732.27 |
| V2756 |
Eye glass case |
228 |
212 |
$223.63 |
| 92015 |
Determination of refractive state |
2,587 |
2,569 |
$60.20 |