| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,922 |
2,907 |
$248K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,654 |
2,640 |
$187K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
6,094 |
6,055 |
$109K |
| 92015 |
Determination of refractive state |
6,284 |
6,246 |
$95K |
| 92250 |
|
225 |
220 |
$7K |
| V2020 |
Frames, purchases |
65 |
64 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
65 |
64 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
42 |
41 |
$385.00 |