| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
135 |
123 |
$9K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
66 |
58 |
$5K |
| V2020 |
Frames, purchases |
126 |
112 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
47 |
47 |
$865.80 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
38 |
38 |
$721.50 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
26 |
25 |
$296.64 |
| 92015 |
Determination of refractive state |
208 |
184 |
$0.00 |