| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
46 |
45 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
62 |
59 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
54 |
52 |
$2K |
| V2020 |
Frames, purchases |
46 |
44 |
$1K |
| 92015 |
Determination of refractive state |
123 |
115 |
$255.78 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
34 |
27 |
$200.00 |
| V2755 |
U-v lens, per lens |
14 |
13 |
$0.00 |