| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
520 |
507 |
$22K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
460 |
445 |
$21K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
982 |
963 |
$21K |
| 92015 |
Determination of refractive state |
1,465 |
1,415 |
$12K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
21 |
21 |
$532.48 |
| V2020 |
Frames, purchases |
23 |
23 |
$441.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
18 |
18 |
$208.00 |