| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
182 |
182 |
$24K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
173 |
173 |
$19K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
458 |
456 |
$14K |
| 92015 |
Determination of refractive state |
643 |
642 |
$11K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
326 |
325 |
$9K |
| V2020 |
Frames, purchases |
481 |
477 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$251.10 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
418 |
416 |
$0.00 |