| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,157 |
1,157 |
$89K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
285 |
285 |
$27K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
638 |
637 |
$19K |
| 92015 |
Determination of refractive state |
1,073 |
1,072 |
$17K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
540 |
538 |
$15K |
| V2020 |
Frames, purchases |
621 |
619 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
31 |
31 |
$864.90 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
632 |
630 |
$0.00 |