| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
435 |
417 |
$19K |
| V2020 |
Frames, purchases |
469 |
439 |
$12K |
| 92002 |
|
197 |
191 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
315 |
297 |
$9K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
123 |
113 |
$8K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
243 |
234 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
20 |
12 |
$989.40 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
72 |
63 |
$579.66 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
40 |
26 |
$504.40 |
| 92370 |
|
15 |
15 |
$424.85 |
| 92015 |
Determination of refractive state |
166 |
145 |
$0.00 |