| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
358 |
358 |
$16K |
| 92015 |
Determination of refractive state |
784 |
782 |
$4K |
| V2020 |
Frames, purchases |
271 |
269 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
79 |
79 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
30 |
30 |
$903.88 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
64 |
41 |
$760.22 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
50 |
25 |
$0.00 |
| 3072F |
|
12 |
12 |
$0.00 |