| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,656 |
1,363 |
$44K |
| 92015 |
Determination of refractive state |
3,724 |
2,362 |
$29K |
| V2020 |
Frames, purchases |
1,157 |
661 |
$17K |
| 92002 |
|
514 |
378 |
$16K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
972 |
866 |
$15K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
418 |
355 |
$5K |
| V2204 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
329 |
91 |
$2K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
319 |
91 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
50 |
25 |
$451.02 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
32 |
16 |
$178.84 |