| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
154 |
152 |
$9K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
122 |
116 |
$7K |
| V2020 |
Frames, purchases |
481 |
439 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
152 |
134 |
$435.00 |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
32 |
25 |
$119.36 |
| 92015 |
Determination of refractive state |
259 |
244 |
$83.70 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
65 |
60 |
$0.00 |
| 92342 |
|
16 |
16 |
$0.00 |