| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
580 |
566 |
$8K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
67 |
67 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$1K |
| S9986 |
Not medically necessary service (patient is aware that service not medically necessary) |
179 |
178 |
$975.00 |
| V2020 |
Frames, purchases |
12 |
12 |
$859.80 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
24 |
12 |
$848.60 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
24 |
12 |
$636.80 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
12 |
12 |
$383.88 |