| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
338 |
338 |
$37K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
579 |
576 |
$18K |
| 92015 |
Determination of refractive state |
678 |
678 |
$12K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
74 |
74 |
$9K |
| V2020 |
Frames, purchases |
653 |
651 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
161 |
161 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
16 |
16 |
$446.40 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
626 |
624 |
$0.00 |