| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
780 |
755 |
$32K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
705 |
685 |
$28K |
| V2020 |
Frames, purchases |
183 |
175 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
61 |
59 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
30 |
30 |
$522.00 |
| 92015 |
Determination of refractive state |
25 |
25 |
$500.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$175.00 |