| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
458 |
456 |
$30K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
870 |
864 |
$17K |
| 92015 |
Determination of refractive state |
1,109 |
1,104 |
$12K |
| V2020 |
Frames, purchases |
338 |
334 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
111 |
111 |
$8K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
93 |
90 |
$7K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
33 |
33 |
$3K |
| 92370 |
|
422 |
422 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
41 |
37 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
122 |
121 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
51 |
51 |
$590.10 |