| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,824 |
3,824 |
$401K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
3,887 |
3,819 |
$116K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
4,068 |
3,962 |
$85K |
| 92015 |
Determination of refractive state |
3,648 |
3,645 |
$63K |
| V2020 |
Frames, purchases |
3,892 |
3,824 |
$39K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
130 |
130 |
$15K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
80 |
80 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
35 |
35 |
$525.00 |