| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
612 |
611 |
$17K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
407 |
405 |
$14K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
619 |
618 |
$12K |
| 92081 |
|
693 |
689 |
$11K |
| 92225 |
|
242 |
242 |
$5K |
| 92015 |
Determination of refractive state |
742 |
738 |
$3K |
| 92202 |
|
101 |
98 |
$114.10 |
| V2020 |
Frames, purchases |
703 |
684 |
$72.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
289 |
143 |
$64.60 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
863 |
424 |
$63.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
80 |
39 |
$0.00 |