| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
330 |
330 |
$43K |
| 92015 |
Determination of refractive state |
416 |
409 |
$7K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
236 |
236 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
235 |
235 |
$7K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
60 |
60 |
$6K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
42 |
42 |
$3K |
| 92250 |
|
98 |
98 |
$3K |
| V2020 |
Frames, purchases |
244 |
244 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
170 |
170 |
$0.00 |