| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
67 |
67 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
29 |
29 |
$1K |
| V2020 |
Frames, purchases |
181 |
180 |
$863.11 |
| 92015 |
Determination of refractive state |
271 |
270 |
$593.49 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
173 |
173 |
$65.00 |
| G0117 |
Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist |
28 |
28 |
$0.00 |
| 2022F |
|
14 |
14 |
$0.00 |
| 92342 |
|
28 |
28 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
28 |
26 |
$0.00 |
| V2756 |
Eye glass case |
13 |
13 |
$0.00 |