| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
224 |
224 |
$10K |
| 92015 |
Determination of refractive state |
540 |
534 |
$8K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
157 |
156 |
$7K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
91 |
91 |
$3K |
| V2020 |
Frames, purchases |
68 |
68 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
31 |
31 |
$382.02 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
24 |
24 |
$293.48 |