| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,402 |
1,356 |
$57K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
613 |
599 |
$23K |
| 92015 |
Determination of refractive state |
2,474 |
2,398 |
$20K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
541 |
530 |
$11K |
| V2020 |
Frames, purchases |
167 |
166 |
$2K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
12 |
12 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
28 |
28 |
$671.76 |
| 92341 |
|
13 |
13 |
$283.19 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
14 |
14 |
$130.00 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
13 |
12 |
$87.00 |
| 3072F |
|
141 |
138 |
$0.00 |