| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,225 |
1,225 |
$125K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,739 |
1,724 |
$53K |
| 92015 |
Determination of refractive state |
1,655 |
1,655 |
$29K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
212 |
212 |
$26K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
828 |
822 |
$23K |
| V2020 |
Frames, purchases |
1,833 |
1,815 |
$19K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
36 |
36 |
$990.45 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,760 |
1,751 |
$221.64 |