| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
593 |
571 |
$27K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
345 |
337 |
$17K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
633 |
621 |
$14K |
| 92015 |
Determination of refractive state |
222 |
216 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
13 |
$182.00 |
| V2020 |
Frames, purchases |
16 |
16 |
$175.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
28 |
28 |
$96.00 |