| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,301 |
1,301 |
$132K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,355 |
1,355 |
$40K |
| 92015 |
Determination of refractive state |
1,676 |
1,676 |
$30K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
202 |
202 |
$25K |
| V2020 |
Frames, purchases |
1,366 |
1,365 |
$14K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
487 |
487 |
$14K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
78 |
78 |
$2K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
12 |
12 |
$334.80 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,367 |
1,367 |
$0.00 |