| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
196 |
155 |
$14K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
177 |
129 |
$8K |
| 92015 |
Determination of refractive state |
654 |
491 |
$7K |
| V2020 |
Frames, purchases |
432 |
271 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
367 |
148 |
$3K |
| 92060 |
|
88 |
56 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
62 |
27 |
$810.72 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
48 |
26 |
$400.00 |