| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
400 |
400 |
$41K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
223 |
223 |
$26K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
466 |
463 |
$14K |
| 92015 |
Determination of refractive state |
570 |
570 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
322 |
321 |
$8K |
| V2020 |
Frames, purchases |
464 |
462 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
122 |
122 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
476 |
473 |
$0.00 |