| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
415 |
402 |
$17K |
| V2020 |
Frames, purchases |
427 |
404 |
$15K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
223 |
215 |
$9K |
| 92015 |
Determination of refractive state |
671 |
645 |
$8K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
352 |
346 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
396 |
370 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
358 |
344 |
$4K |