| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,379 |
3,287 |
$152K |
| 92015 |
Determination of refractive state |
3,750 |
3,667 |
$56K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
706 |
679 |
$20K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
272 |
265 |
$12K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
138 |
108 |
$6K |
| V2025 |
Deluxe frame |
64 |
56 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
27 |
27 |
$1K |
| V2020 |
Frames, purchases |
28 |
28 |
$1K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
13 |
13 |
$577.85 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
32 |
27 |
$409.02 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
28 |
28 |
$360.08 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
28 |
28 |
$357.34 |