| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
197 |
190 |
$23K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
211 |
209 |
$22K |
| V2020 |
Frames, purchases |
183 |
174 |
$8K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
27 |
25 |
$2K |
| 92015 |
Determination of refractive state |
238 |
229 |
$167.10 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
181 |
173 |
$47.18 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
247 |
119 |
$0.00 |
| V2755 |
U-v lens, per lens |
34 |
15 |
$0.00 |
| 92083 |
|
12 |
12 |
$0.00 |
| 92133 |
|
12 |
12 |
$0.00 |