| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
258 |
249 |
$21K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
358 |
347 |
$9K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
97 |
87 |
$9K |
| 92015 |
Determination of refractive state |
618 |
587 |
$7K |
| V2020 |
Frames, purchases |
56 |
51 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
70 |
29 |
$484.12 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
30 |
12 |
$439.92 |