| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
219 |
206 |
$14K |
| V2020 |
Frames, purchases |
347 |
300 |
$9K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
230 |
207 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
43 |
43 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
92 |
64 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
66 |
45 |
$432.00 |
| 92015 |
Determination of refractive state |
496 |
461 |
$202.20 |