| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
151 |
138 |
$16K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
87 |
84 |
$8K |
| V2020 |
Frames, purchases |
103 |
99 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
64 |
61 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
87 |
83 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
67 |
64 |
$434.98 |