| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
109 |
109 |
$8K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
392 |
389 |
$8K |
| 92015 |
Determination of refractive state |
513 |
499 |
$6K |
| V2020 |
Frames, purchases |
203 |
200 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
50 |
49 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
252 |
249 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
15 |
14 |
$181.36 |