| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
127 |
127 |
$5K |
| V2020 |
Frames, purchases |
113 |
113 |
$4K |
| 92015 |
Determination of refractive state |
221 |
221 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
83 |
83 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
40 |
40 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
112 |
112 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
29 |
29 |
$319.00 |