| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,105 |
1,103 |
$51K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,556 |
1,550 |
$29K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
292 |
290 |
$13K |
| V2020 |
Frames, purchases |
534 |
529 |
$12K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
131 |
131 |
$6K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
39 |
38 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
28 |
28 |
$810.08 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
14 |
14 |
$362.22 |