| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
55 |
55 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
50 |
50 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
13 |
13 |
$1K |
| 92015 |
Determination of refractive state |
67 |
67 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
38 |
38 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
37 |
37 |
$990.45 |
| V2020 |
Frames, purchases |
39 |
39 |
$390.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
35 |
35 |
$0.00 |