| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
774 |
770 |
$34K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
512 |
508 |
$24K |
| V2020 |
Frames, purchases |
1,169 |
1,164 |
$21K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
813 |
812 |
$18K |
| 92341 |
|
346 |
343 |
$9K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
37 |
37 |
$2K |
| 92015 |
Determination of refractive state |
94 |
91 |
$1K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
18 |
18 |
$773.28 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
25 |
25 |
$622.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
20 |
20 |
$234.00 |