| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
300 |
269 |
$14K |
| 92015 |
Determination of refractive state |
364 |
331 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
66 |
64 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
26 |
26 |
$1K |
| V2020 |
Frames, purchases |
59 |
58 |
$967.84 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
13 |
13 |
$585.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
13 |
$167.18 |