| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
316 |
316 |
$40K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
358 |
358 |
$39K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
731 |
729 |
$22K |
| 92015 |
Determination of refractive state |
1,236 |
1,235 |
$22K |
| V2020 |
Frames, purchases |
824 |
821 |
$8K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
315 |
315 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
59 |
59 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
479 |
478 |
$0.00 |