| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
647 |
645 |
$62K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
557 |
554 |
$39K |
| V2020 |
Frames, purchases |
987 |
981 |
$24K |
| 92015 |
Determination of refractive state |
961 |
956 |
$14K |
| 92370 |
|
963 |
958 |
$14K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
343 |
341 |
$8K |
| V2756 |
Eye glass case |
948 |
943 |
$929.88 |