| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
696 |
696 |
$72K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,100 |
1,099 |
$33K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
131 |
131 |
$15K |
| 92015 |
Determination of refractive state |
809 |
809 |
$14K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
573 |
573 |
$14K |
| V2020 |
Frames, purchases |
1,117 |
1,117 |
$11K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
28 |
28 |
$641.70 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,124 |
1,123 |
$0.00 |