| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
467 |
442 |
$21K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
385 |
384 |
$17K |
| 92015 |
Determination of refractive state |
1,066 |
1,025 |
$16K |
| V2020 |
Frames, purchases |
257 |
257 |
$9K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
207 |
207 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
81 |
81 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
13 |
$737.90 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
12 |
12 |
$540.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
25 |
25 |
$261.58 |