| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
79 |
78 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
84 |
82 |
$5K |
| 92015 |
Determination of refractive state |
182 |
179 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
153 |
150 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
119 |
117 |
$2K |
| V2020 |
Frames, purchases |
88 |
86 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
17 |
17 |
$110.00 |
| V2025 |
Deluxe frame |
69 |
68 |
$0.00 |