| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
151 |
151 |
$17K |
| V2020 |
Frames, purchases |
229 |
228 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
29 |
29 |
$4K |
| 92015 |
Determination of refractive state |
248 |
247 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
215 |
213 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
209 |
208 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
231 |
230 |
$690.00 |
| V2755 |
U-v lens, per lens |
231 |
230 |
$0.00 |