| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
179 |
179 |
$10K |
| 92015 |
Determination of refractive state |
281 |
281 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
155 |
155 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
104 |
104 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
185 |
184 |
$2K |
| V2020 |
Frames, purchases |
212 |
212 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
146 |
145 |
$2K |