| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
353 |
353 |
$37K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
431 |
428 |
$13K |
| 92015 |
Determination of refractive state |
461 |
461 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
43 |
43 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
193 |
193 |
$4K |
| V2020 |
Frames, purchases |
442 |
441 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
28 |
28 |
$558.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
429 |
429 |
$0.00 |