| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
201 |
198 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
200 |
198 |
$7K |
| V2025 |
Deluxe frame |
78 |
78 |
$1K |
| 92002 |
|
12 |
12 |
$530.00 |
| 92015 |
Determination of refractive state |
222 |
220 |
$122.74 |
| V2020 |
Frames, purchases |
114 |
114 |
$58.02 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
30 |
30 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
17 |
12 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
48 |
48 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
34 |
26 |
$0.00 |