| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
455 |
453 |
$21K |
| 92015 |
Determination of refractive state |
935 |
925 |
$15K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
325 |
325 |
$14K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
420 |
418 |
$12K |
| V2020 |
Frames, purchases |
346 |
344 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
95 |
95 |
$1K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
16 |
16 |
$743.20 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
58 |
58 |
$580.90 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$127.60 |