| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
143 |
140 |
$7K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
114 |
111 |
$6K |
| 92015 |
Determination of refractive state |
381 |
366 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
153 |
152 |
$810.00 |
| V2020 |
Frames, purchases |
42 |
37 |
$762.20 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
29 |
13 |
$355.58 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
24 |
12 |
$272.16 |