| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
291 |
286 |
$7K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
92 |
91 |
$2K |
| 92250 |
|
55 |
54 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
29 |
26 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
40 |
40 |
$915.60 |
| 92015 |
Determination of refractive state |
364 |
361 |
$673.20 |
| V2020 |
Frames, purchases |
119 |
118 |
$140.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
149 |
75 |
$21.00 |
| V2760 |
Scratch resistant coating, per lens |
26 |
13 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
53 |
26 |
$0.00 |