| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
244 |
235 |
$11K |
| 92015 |
Determination of refractive state |
299 |
274 |
$5K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
117 |
81 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
57 |
50 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
53 |
44 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
24 |
24 |
$1K |
| V2025 |
Deluxe frame |
27 |
27 |
$502.24 |
| V2020 |
Frames, purchases |
20 |
13 |
$471.60 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
18 |
12 |
$252.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
19 |
12 |
$90.00 |