| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,577 |
3,564 |
$99K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
4,533 |
4,525 |
$98K |
| V2020 |
Frames, purchases |
6,040 |
6,034 |
$77K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
4,381 |
4,378 |
$57K |
| 92015 |
Determination of refractive state |
7,348 |
7,340 |
$33K |
| 92341 |
|
1,575 |
1,575 |
$30K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
533 |
524 |
$13K |
| V2025 |
Deluxe frame |
89 |
89 |
$9K |
| V2744 |
Tint, photochromatic, per lens |
24 |
24 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
27 |
27 |
$897.27 |