| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
191 |
191 |
$9K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
152 |
152 |
$8K |
| V2020 |
Frames, purchases |
407 |
407 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
217 |
217 |
$4K |
| 92015 |
Determination of refractive state |
626 |
626 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
55 |
55 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
25 |
25 |
$572.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
32 |
32 |
$540.00 |