| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
86 |
86 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
79 |
79 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
86 |
86 |
$2K |
| V2020 |
Frames, purchases |
112 |
112 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
13 |
13 |
$780.36 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
52 |
52 |
$415.00 |