| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,954 |
1,940 |
$119K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,024 |
1,016 |
$71K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,527 |
2,488 |
$41K |
| 92015 |
Determination of refractive state |
3,119 |
3,095 |
$40K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
16 |
15 |
$224.00 |
| V2020 |
Frames, purchases |
16 |
15 |
$160.00 |
| V2760 |
Scratch resistant coating, per lens |
16 |
15 |
$160.00 |