| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
400 |
400 |
$41K |
| 92015 |
Determination of refractive state |
909 |
908 |
$16K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
482 |
480 |
$14K |
| V2020 |
Frames, purchases |
674 |
668 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
155 |
154 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
28 |
28 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
30 |
30 |
$837.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
724 |
719 |
$0.00 |