| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
215 |
158 |
$10K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
206 |
202 |
$9K |
| 92015 |
Determination of refractive state |
391 |
387 |
$7K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
124 |
124 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
21 |
16 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
15 |
15 |
$691.75 |
| V2025 |
Deluxe frame |
24 |
18 |
$259.20 |