| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
67 |
63 |
$1K |
| 92015 |
Determination of refractive state |
109 |
101 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
72 |
67 |
$820.30 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
17 |
16 |
$654.36 |
| V2020 |
Frames, purchases |
45 |
43 |
$407.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
42 |
38 |
$341.00 |
| V2025 |
Deluxe frame |
32 |
30 |
$0.00 |