| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
395 |
384 |
$35K |
| V2020 |
Frames, purchases |
566 |
532 |
$14K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
228 |
224 |
$11K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
617 |
404 |
$10K |
| 92015 |
Determination of refractive state |
1,727 |
1,670 |
$10K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
26 |
25 |
$2K |
| V2756 |
Eye glass case |
394 |
361 |
$391.46 |