| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
457 |
421 |
$40K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
124 |
121 |
$14K |
| V2020 |
Frames, purchases |
401 |
374 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
307 |
282 |
$916.13 |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
199 |
182 |
$450.00 |
| 92015 |
Determination of refractive state |
1,078 |
991 |
$321.58 |
| 92250 |
|
14 |
14 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$0.00 |