| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,865 |
1,778 |
$165K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
760 |
717 |
$45K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
528 |
511 |
$25K |
| 92015 |
Determination of refractive state |
4,028 |
3,787 |
$22K |
| V2020 |
Frames, purchases |
83 |
66 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
28 |
24 |
$727.28 |
| V2760 |
Scratch resistant coating, per lens |
54 |
39 |
$678.56 |
| 1036F |
|
102 |
100 |
$0.00 |
| 1000F |
|
104 |
101 |
$0.00 |
| 92310 |
|
18 |
15 |
$0.00 |
| 1159F |
|
490 |
455 |
$0.00 |