| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,202 |
1,201 |
$84K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
597 |
591 |
$48K |
| 92015 |
Determination of refractive state |
2,266 |
2,254 |
$33K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,360 |
1,356 |
$23K |
| 92250 |
|
315 |
315 |
$8K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
308 |
307 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
187 |
187 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
31 |
31 |
$205.70 |