| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
123 |
121 |
$11K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
73 |
63 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
159 |
148 |
$867.44 |
| 92015 |
Determination of refractive state |
266 |
248 |
$120.00 |
| V2020 |
Frames, purchases |
192 |
183 |
$77.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
120 |
108 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
26 |
25 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
13 |
$0.00 |