| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
568 |
568 |
$72K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
527 |
527 |
$57K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,321 |
1,312 |
$40K |
| 92015 |
Determination of refractive state |
1,520 |
1,520 |
$27K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
638 |
638 |
$16K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
542 |
538 |
$14K |
| V2020 |
Frames, purchases |
1,323 |
1,314 |
$13K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
81 |
81 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
964 |
964 |
$0.00 |