| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
146 |
144 |
$4K |
| 92250 |
|
170 |
169 |
$4K |
| 92015 |
Determination of refractive state |
180 |
179 |
$3K |
| 92341 |
|
114 |
112 |
$1K |
| 99308 |
Subsequent nursing facility care, per day, straightforward |
15 |
15 |
$447.72 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
30 |
30 |
$316.95 |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
36 |
36 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
64 |
62 |
$0.00 |
| V2020 |
Frames, purchases |
13 |
13 |
$0.00 |