| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
786 |
785 |
$83K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
929 |
924 |
$26K |
| 92015 |
Determination of refractive state |
1,203 |
1,200 |
$21K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
142 |
142 |
$18K |
| V2020 |
Frames, purchases |
1,120 |
1,117 |
$11K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
234 |
234 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
28 |
28 |
$767.25 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,063 |
1,058 |
$0.00 |