| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
517 |
364 |
$23K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
444 |
305 |
$19K |
| 92015 |
Determination of refractive state |
966 |
705 |
$18K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
631 |
437 |
$17K |
| V2020 |
Frames, purchases |
79 |
64 |
$1K |
| 92341 |
|
25 |
24 |
$683.16 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
51 |
31 |
$457.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
46 |
29 |
$186.48 |