| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
395 |
395 |
$43K |
| 92015 |
Determination of refractive state |
1,079 |
1,079 |
$19K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
105 |
105 |
$13K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
412 |
412 |
$13K |
| V2020 |
Frames, purchases |
459 |
459 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
53 |
53 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$334.80 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
487 |
487 |
$0.00 |