| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
395 |
343 |
$29K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
222 |
203 |
$13K |
| 92015 |
Determination of refractive state |
837 |
709 |
$10K |
| V2020 |
Frames, purchases |
47 |
43 |
$820.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
21 |
19 |
$804.18 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
13 |
12 |
$694.86 |