| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
385 |
380 |
$24K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
256 |
248 |
$21K |
| V2020 |
Frames, purchases |
482 |
472 |
$16K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
340 |
333 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
232 |
228 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
208 |
203 |
$1K |
| 92341 |
|
15 |
15 |
$165.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$150.00 |
| 92015 |
Determination of refractive state |
705 |
692 |
$60.66 |