| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
960 |
960 |
$100K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
360 |
360 |
$45K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,189 |
1,188 |
$36K |
| 92015 |
Determination of refractive state |
1,753 |
1,753 |
$31K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
618 |
615 |
$17K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
542 |
540 |
$15K |
| V2020 |
Frames, purchases |
1,146 |
1,142 |
$11K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
41 |
40 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,214 |
1,209 |
$0.00 |