| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
258 |
258 |
$33K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,027 |
1,024 |
$31K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
260 |
260 |
$29K |
| 92015 |
Determination of refractive state |
1,220 |
1,211 |
$22K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
499 |
497 |
$14K |
| V2020 |
Frames, purchases |
1,064 |
1,062 |
$11K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
90 |
90 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
76 |
76 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,039 |
1,037 |
$0.00 |