| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
246 |
245 |
$23K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
274 |
271 |
$19K |
| V2020 |
Frames, purchases |
366 |
361 |
$10K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
111 |
110 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
116 |
105 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
138 |
137 |
$606.50 |
| 92015 |
Determination of refractive state |
139 |
136 |
$277.08 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$200.00 |