| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
335 |
331 |
$29K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
317 |
317 |
$23K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
584 |
582 |
$19K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
141 |
139 |
$14K |
| V2025 |
Deluxe frame |
234 |
234 |
$6K |
| V2020 |
Frames, purchases |
319 |
317 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
207 |
194 |
$2K |
| 92015 |
Determination of refractive state |
750 |
747 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
411 |
411 |
$0.00 |