| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
264 |
264 |
$31K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
314 |
314 |
$27K |
| 99205 |
Prolong outpt/office vis |
98 |
98 |
$17K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
413 |
412 |
$12K |
| 92015 |
Determination of refractive state |
416 |
416 |
$7K |
| V2020 |
Frames, purchases |
413 |
412 |
$4K |
| 99215 |
Prolong outpt/office vis |
27 |
27 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
69 |
69 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
13 |
$348.75 |