| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,994 |
1,910 |
$90K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
550 |
549 |
$16K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
240 |
203 |
$11K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
97 |
84 |
$4K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
82 |
82 |
$4K |
| 92015 |
Determination of refractive state |
180 |
180 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
49 |
49 |
$2K |
| 92341 |
|
28 |
28 |
$815.56 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
30 |
30 |
$0.00 |
| V2020 |
Frames, purchases |
57 |
56 |
$0.00 |