| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,791 |
1,703 |
$105K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
358 |
341 |
$20K |
| V2020 |
Frames, purchases |
42 |
42 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
38 |
38 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
40 |
40 |
$760.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
30 |
30 |
$232.00 |
| 92015 |
Determination of refractive state |
15 |
15 |
$55.00 |