| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
789 |
789 |
$82K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
913 |
908 |
$28K |
| 92015 |
Determination of refractive state |
1,263 |
1,263 |
$22K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
105 |
105 |
$13K |
| V2020 |
Frames, purchases |
960 |
955 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
273 |
271 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
28 |
28 |
$697.50 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
919 |
915 |
$0.00 |