| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
474 |
460 |
$21K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
444 |
438 |
$19K |
| V2020 |
Frames, purchases |
717 |
706 |
$14K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
465 |
459 |
$12K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
307 |
301 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
172 |
163 |
$3K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
13 |
13 |
$490.10 |
| 92341 |
|
14 |
14 |
$364.58 |
| 92015 |
Determination of refractive state |
26 |
26 |
$0.00 |