| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
451 |
451 |
$23K |
| 92015 |
Determination of refractive state |
875 |
875 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
125 |
125 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
297 |
297 |
$6K |
| V2020 |
Frames, purchases |
268 |
268 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
101 |
101 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
180 |
180 |
$720.00 |