| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
195 |
189 |
$4K |
| 92250 |
|
215 |
200 |
$4K |
| 92015 |
Determination of refractive state |
198 |
188 |
$3K |
| 92341 |
|
111 |
104 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
73 |
70 |
$756.88 |
| 92273 |
|
14 |
13 |
$310.20 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
15 |
15 |
$143.70 |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
28 |
25 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
14 |
14 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
143 |
135 |
$0.00 |
| V2020 |
Frames, purchases |
99 |
94 |
$0.00 |