| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
5,153 |
5,143 |
$373K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,579 |
1,572 |
$131K |
| 92015 |
Determination of refractive state |
7,154 |
7,115 |
$113K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
5,588 |
5,538 |
$95K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
964 |
628 |
$39K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
45 |
26 |
$1K |
| V2020 |
Frames, purchases |
18 |
18 |
$900.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
18 |
18 |
$700.00 |