| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,180 |
1,176 |
$35K |
| 92015 |
Determination of refractive state |
1,380 |
1,376 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
131 |
131 |
$3K |
| 92310 |
|
15 |
15 |
$720.00 |
| 92225 |
|
18 |
18 |
$692.30 |
| 92060 |
|
14 |
14 |
$294.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
25 |
25 |
$240.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
136 |
134 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
80 |
79 |
$0.00 |
| V2020 |
Frames, purchases |
306 |
303 |
$0.00 |