| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
822 |
763 |
$66K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,166 |
1,064 |
$56K |
| V2020 |
Frames, purchases |
1,321 |
1,281 |
$32K |
| 92015 |
Determination of refractive state |
2,604 |
2,456 |
$31K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
206 |
178 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
219 |
214 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
158 |
154 |
$4K |
| V2756 |
Eye glass case |
1,269 |
1,235 |
$1K |
| 92136 |
|
31 |
13 |
$780.87 |
| 92133 |
|
14 |
13 |
$360.15 |