| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
329 |
254 |
$16K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
284 |
215 |
$11K |
| 92015 |
Determination of refractive state |
775 |
613 |
$4K |
| V2020 |
Frames, purchases |
672 |
516 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
555 |
443 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
341 |
240 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
477 |
363 |
$756.98 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
37 |
13 |
$85.26 |
| 92341 |
|
28 |
12 |
$60.00 |