| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
291 |
291 |
$14K |
| 92015 |
Determination of refractive state |
576 |
576 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
193 |
192 |
$4K |
| V2020 |
Frames, purchases |
195 |
193 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
14 |
14 |
$484.94 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
38 |
27 |
$314.16 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
127 |
63 |
$0.00 |