| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
282 |
274 |
$16K |
| V2020 |
Frames, purchases |
689 |
593 |
$15K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
110 |
106 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
560 |
473 |
$3K |
| 92015 |
Determination of refractive state |
690 |
670 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
422 |
339 |
$1K |
| 92342 |
|
76 |
76 |
$43.36 |
| 3072F |
|
19 |
19 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
24 |
24 |
$0.00 |
| V2756 |
Eye glass case |
75 |
75 |
$0.00 |
| 2022F |
|
70 |
70 |
$0.00 |
| G8785 |
Blood pressure reading not documented, reason not given |
13 |
13 |
$0.00 |