| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
69 |
67 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
50 |
49 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
77 |
75 |
$484.00 |
| V2020 |
Frames, purchases |
130 |
125 |
$332.00 |
| 2023F |
|
20 |
20 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
67 |
63 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
17 |
17 |
$0.00 |
| 92015 |
Determination of refractive state |
133 |
130 |
$0.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
111 |
107 |
$0.00 |