| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
343 |
338 |
$7K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
151 |
146 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
28 |
28 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
26 |
26 |
$2K |
| V2020 |
Frames, purchases |
42 |
42 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
13 |
$540.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
28 |
28 |
$252.00 |
| 99309 |
Subsequent nursing facility care, per day, low to moderate complexity |
13 |
13 |
$194.47 |