| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,557 |
1,557 |
$151K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,195 |
2,192 |
$67K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
500 |
500 |
$47K |
| 92015 |
Determination of refractive state |
2,344 |
2,344 |
$42K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,602 |
1,601 |
$41K |
| V2020 |
Frames, purchases |
2,191 |
2,188 |
$22K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$195.30 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,158 |
2,156 |
$0.00 |