| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
233 |
215 |
$23K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
186 |
160 |
$14K |
| V2020 |
Frames, purchases |
419 |
349 |
$8K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
209 |
163 |
$477.81 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
174 |
140 |
$321.00 |
| 92015 |
Determination of refractive state |
234 |
204 |
$225.45 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
14 |
12 |
$49.00 |