| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
162 |
160 |
$11K |
| 92015 |
Determination of refractive state |
643 |
626 |
$7K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
55 |
54 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$660.50 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
51 |
50 |
$642.00 |