| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
105 |
88 |
$7K |
| 92015 |
Determination of refractive state |
169 |
138 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
70 |
60 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
27 |
25 |
$2K |
| V2020 |
Frames, purchases |
116 |
101 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
59 |
50 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
122 |
107 |
$645.06 |
| 92341 |
|
17 |
13 |
$518.25 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
15 |
12 |
$389.76 |
| V2750 |
Anti-reflective coating, per lens |
14 |
13 |
$0.00 |