| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
601 |
590 |
$13K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
114 |
113 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
42 |
41 |
$3K |
| 92250 |
|
61 |
60 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
37 |
37 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
83 |
83 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
36 |
36 |
$701.56 |
| V2020 |
Frames, purchases |
24 |
24 |
$351.72 |