| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
402 |
402 |
$39K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
241 |
241 |
$28K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
495 |
494 |
$15K |
| 92015 |
Determination of refractive state |
687 |
687 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
343 |
339 |
$8K |
| V2020 |
Frames, purchases |
494 |
492 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
57 |
57 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
12 |
12 |
$279.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
504 |
499 |
$0.00 |