| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
656 |
654 |
$30K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
436 |
434 |
$19K |
| 92015 |
Determination of refractive state |
1,249 |
1,244 |
$17K |
| V2020 |
Frames, purchases |
445 |
443 |
$17K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
161 |
159 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
272 |
271 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
174 |
174 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
16 |
16 |
$192.08 |