| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
349 |
347 |
$31K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
229 |
226 |
$24K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
411 |
406 |
$16K |
| V2020 |
Frames, purchases |
704 |
656 |
$14K |
| 92015 |
Determination of refractive state |
765 |
711 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
139 |
139 |
$5K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
28 |
28 |
$1K |
| 92002 |
|
59 |
58 |
$763.62 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
13 |
13 |
$246.20 |