| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,488 |
1,486 |
$15K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
101 |
101 |
$2K |
| 92015 |
Determination of refractive state |
1,372 |
1,371 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
67 |
67 |
$1K |
| V2020 |
Frames, purchases |
643 |
640 |
$360.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
765 |
395 |
$252.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
374 |
193 |
$22.80 |