| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
585 |
580 |
$31K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
229 |
229 |
$14K |
| V2020 |
Frames, purchases |
1,102 |
1,098 |
$13K |
| 92015 |
Determination of refractive state |
1,019 |
1,015 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
512 |
510 |
$9K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,084 |
1,080 |
$8K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
211 |
209 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
39 |
39 |
$663.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
31 |
31 |
$479.40 |