| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
461 |
455 |
$21K |
| 92015 |
Determination of refractive state |
686 |
679 |
$13K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
531 |
517 |
$11K |
| V2020 |
Frames, purchases |
770 |
758 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
14 |
14 |
$688.66 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
704 |
689 |
$442.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
97 |
96 |
$0.00 |