| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
207 |
193 |
$26K |
| V2020 |
Frames, purchases |
397 |
376 |
$25K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
163 |
152 |
$16K |
| V2199 |
Not otherwise classified, single vision lens |
222 |
218 |
$16K |
| 92015 |
Determination of refractive state |
838 |
787 |
$9K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
62 |
62 |
$5K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
17 |
16 |
$1K |