| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
579 |
561 |
$24K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
980 |
958 |
$20K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
255 |
252 |
$12K |
| 92341 |
|
31 |
29 |
$694.22 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
30 |
30 |
$360.00 |
| V2020 |
Frames, purchases |
1,000 |
977 |
$340.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
509 |
502 |
$72.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
340 |
336 |
$0.00 |
| 92015 |
Determination of refractive state |
20 |
20 |
$0.00 |