| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
139 |
139 |
$18K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
149 |
149 |
$16K |
| 92015 |
Determination of refractive state |
403 |
400 |
$7K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
206 |
206 |
$6K |
| V2020 |
Frames, purchases |
251 |
249 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
27 |
27 |
$753.30 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
189 |
189 |
$0.00 |