| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
223 |
208 |
$22K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
54 |
52 |
$6K |
| V2020 |
Frames, purchases |
91 |
74 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
67 |
56 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
130 |
110 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
106 |
85 |
$2K |
| 92015 |
Determination of refractive state |
741 |
712 |
$247.70 |