| Code | Description | Claims | Beneficiaries | Total Paid |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
519 |
515 |
$36K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
746 |
738 |
$14K |
| 92015 |
Determination of refractive state |
986 |
971 |
$12K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
286 |
281 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
56 |
56 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
58 |
58 |
$249.90 |