| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
397 |
396 |
$17K |
| V2020 |
Frames, purchases |
209 |
206 |
$8K |
| 92015 |
Determination of refractive state |
509 |
508 |
$7K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
79 |
78 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
40 |
40 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
65 |
64 |
$796.30 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
63 |
63 |
$727.36 |