| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
379 |
377 |
$40K |
| 92250 |
|
697 |
690 |
$28K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
717 |
712 |
$18K |
| V2020 |
Frames, purchases |
729 |
718 |
$14K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
181 |
176 |
$14K |
| 92083 |
|
168 |
166 |
$11K |
| 92020 |
|
234 |
232 |
$6K |
| 92285 |
|
198 |
198 |
$5K |
| 92082 |
|
68 |
68 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
66 |
64 |
$2K |
| 76514 |
|
96 |
95 |
$813.49 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
24 |
24 |
$314.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
51 |
51 |
$100.00 |
| 92015 |
Determination of refractive state |
124 |
123 |
$19.45 |