| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
173 |
172 |
$14K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
230 |
226 |
$4K |
| V2020 |
Frames, purchases |
266 |
262 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
232 |
228 |
$1K |
| 92015 |
Determination of refractive state |
173 |
172 |
$1K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
13 |
12 |
$900.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
157 |
155 |
$340.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
20 |
20 |
$217.64 |
| 92310 |
|
14 |
14 |
$35.00 |
| 92341 |
|
19 |
19 |
$0.00 |