| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
283 |
270 |
$13K |
| 92015 |
Determination of refractive state |
945 |
891 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
62 |
56 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
269 |
263 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
36 |
18 |
$556.56 |
| V2020 |
Frames, purchases |
20 |
20 |
$412.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
21 |
12 |
$238.14 |