| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
533 |
533 |
$55K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
147 |
147 |
$19K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
620 |
615 |
$18K |
| 92015 |
Determination of refractive state |
912 |
910 |
$16K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
472 |
471 |
$9K |
| V2020 |
Frames, purchases |
681 |
677 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
13 |
$237.15 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
662 |
658 |
$0.00 |