| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
520 |
514 |
$50K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
727 |
718 |
$39K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
147 |
147 |
$10K |
| 92015 |
Determination of refractive state |
279 |
279 |
$5K |
| V2020 |
Frames, purchases |
109 |
108 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
28 |
14 |
$246.48 |