| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,186 |
1,186 |
$124K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,252 |
1,252 |
$37K |
| 92015 |
Determination of refractive state |
2,050 |
2,049 |
$36K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
210 |
210 |
$26K |
| V2020 |
Frames, purchases |
1,274 |
1,274 |
$13K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
256 |
256 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
255 |
255 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
805 |
805 |
$0.00 |