| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
933 |
910 |
$24K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
401 |
395 |
$18K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
151 |
145 |
$13K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
61 |
33 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
717 |
706 |
$2K |
| 92015 |
Determination of refractive state |
1,180 |
1,159 |
$764.97 |
| V2020 |
Frames, purchases |
926 |
887 |
$405.80 |
| 92341 |
|
12 |
12 |
$104.10 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
221 |
124 |
$11.00 |
| 92342 |
|
367 |
367 |
$0.00 |
| V2756 |
Eye glass case |
367 |
367 |
$0.00 |
| 2021F |
|
396 |
396 |
$0.00 |
| G0117 |
Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist |
399 |
399 |
$0.00 |