| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
490 |
433 |
$30K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
740 |
660 |
$29K |
| V2020 |
Frames, purchases |
200 |
159 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
257 |
116 |
$3K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
16 |
13 |
$326.17 |
| 92015 |
Determination of refractive state |
23 |
21 |
$275.00 |