| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
748 |
492 |
$25K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
524 |
520 |
$9K |
| 92015 |
Determination of refractive state |
1,232 |
829 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
50 |
37 |
$1K |
| V2020 |
Frames, purchases |
215 |
211 |
$200.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
132 |
129 |
$126.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
100 |
99 |
$57.00 |
| V2750 |
Anti-reflective coating, per lens |
57 |
57 |
$0.00 |