| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
128 |
115 |
$7K |
| V2020 |
Frames, purchases |
235 |
174 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
72 |
55 |
$3K |
| 92015 |
Determination of refractive state |
386 |
347 |
$350.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
39 |
28 |
$315.69 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
225 |
124 |
$206.80 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
198 |
84 |
$136.35 |