| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
80 |
74 |
$5K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
28 |
28 |
$3K |
| V2025 |
Deluxe frame |
35 |
32 |
$397.50 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
14 |
14 |
$45.34 |
| 92015 |
Determination of refractive state |
14 |
14 |
$14.94 |
| V2755 |
U-v lens, per lens |
27 |
24 |
$12.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
12 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
24 |
24 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
13 |
13 |
$0.00 |
| G0117 |
Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist |
13 |
13 |
$0.00 |
| 2022F |
|
14 |
13 |
$0.00 |