| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
177 |
177 |
$11K |
| 92015 |
Determination of refractive state |
258 |
258 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
103 |
102 |
$3K |
| V2020 |
Frames, purchases |
101 |
100 |
$938.55 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
13 |
13 |
$904.31 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
27 |
27 |
$626.03 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
111 |
111 |
$0.00 |