| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
670 |
610 |
$58K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
496 |
462 |
$36K |
| 92134 |
|
1,014 |
912 |
$10K |
| V2020 |
Frames, purchases |
62 |
60 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
24 |
13 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
34 |
28 |
$948.69 |
| 92015 |
Determination of refractive state |
173 |
171 |
$14.46 |