| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
241 |
229 |
$16K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
77 |
77 |
$8K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
160 |
159 |
$5K |
| V2020 |
Frames, purchases |
136 |
133 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
169 |
145 |
$2K |
| 92015 |
Determination of refractive state |
490 |
474 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
44 |
39 |
$852.40 |