| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,739 |
1,675 |
$129K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
342 |
336 |
$32K |
| 92015 |
Determination of refractive state |
2,044 |
1,961 |
$23K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
904 |
863 |
$18K |
| V2025 |
Deluxe frame |
230 |
223 |
$14K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
236 |
214 |
$12K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
274 |
258 |
$11K |
| V2020 |
Frames, purchases |
634 |
613 |
$11K |
| V2750 |
Anti-reflective coating, per lens |
106 |
106 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
101 |
101 |
$3K |
| 92250 |
|
25 |
24 |
$1K |