| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
81 |
80 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
69 |
68 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
17 |
17 |
$516.80 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$480.00 |
| 92015 |
Determination of refractive state |
156 |
156 |
$475.31 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
83 |
82 |
$409.36 |
| V2020 |
Frames, purchases |
77 |
76 |
$320.00 |