| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
149 |
148 |
$12K |
| 92015 |
Determination of refractive state |
323 |
317 |
$7K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
54 |
40 |
$1K |
| V2020 |
Frames, purchases |
83 |
69 |
$806.88 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$753.36 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
47 |
24 |
$574.26 |
| 99199 |
Unlisted special service, procedure or report |
165 |
165 |
$0.00 |