| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
401 |
401 |
$23K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
773 |
765 |
$15K |
| 92015 |
Determination of refractive state |
1,431 |
1,420 |
$12K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
73 |
73 |
$5K |
| V2020 |
Frames, purchases |
243 |
241 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
147 |
147 |
$4K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
36 |
36 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
24 |
24 |
$1K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
16 |
16 |
$827.20 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
13 |
$78.00 |