| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
129 |
128 |
$7K |
| 92015 |
Determination of refractive state |
240 |
204 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
88 |
86 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
34 |
27 |
$2K |
| V2020 |
Frames, purchases |
156 |
151 |
$1K |
| 92250 |
|
33 |
28 |
$540.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
18 |
18 |
$225.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
29 |
26 |
$121.50 |