| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
126 |
124 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
424 |
340 |
$4K |
| 92015 |
Determination of refractive state |
260 |
257 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
398 |
315 |
$2K |
| V2020 |
Frames, purchases |
518 |
513 |
$960.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
25 |
25 |
$960.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
512 |
508 |
$864.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
36 |
27 |
$220.00 |