| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
566 |
555 |
$60K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
614 |
597 |
$55K |
| V2020 |
Frames, purchases |
652 |
351 |
$21K |
| 92015 |
Determination of refractive state |
1,071 |
1,049 |
$14K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
342 |
312 |
$7K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
26 |
23 |
$1K |