| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
132 |
125 |
$12K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
109 |
106 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
329 |
308 |
$6K |
| V2025 |
Deluxe frame |
219 |
210 |
$4K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
36 |
36 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
32 |
30 |
$2K |
| V2020 |
Frames, purchases |
15 |
15 |
$255.00 |
| 92015 |
Determination of refractive state |
344 |
333 |
$55.36 |