| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
414 |
413 |
$19K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
409 |
407 |
$18K |
| 92015 |
Determination of refractive state |
917 |
908 |
$13K |
| V2020 |
Frames, purchases |
275 |
273 |
$11K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
202 |
199 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
191 |
191 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
55 |
55 |
$638.01 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
13 |
$176.42 |