| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
81 |
81 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
206 |
203 |
$4K |
| 92015 |
Determination of refractive state |
311 |
310 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
29 |
29 |
$2K |
| V2020 |
Frames, purchases |
169 |
167 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
58 |
57 |
$700.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
168 |
167 |
$654.00 |