| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
639 |
618 |
$53K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
390 |
374 |
$40K |
| 92015 |
Determination of refractive state |
1,594 |
1,520 |
$22K |
| V2020 |
Frames, purchases |
73 |
73 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
74 |
74 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
70 |
70 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
29 |
29 |
$2K |
| 92250 |
|
15 |
12 |
$214.96 |