| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
136 |
134 |
$8K |
| V2020 |
Frames, purchases |
297 |
296 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
137 |
136 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
290 |
289 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
24 |
24 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
51 |
51 |
$985.44 |
| 92015 |
Determination of refractive state |
171 |
171 |
$101.81 |