| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
835 |
835 |
$90K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
243 |
243 |
$31K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
912 |
912 |
$28K |
| 92015 |
Determination of refractive state |
1,520 |
1,520 |
$27K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
524 |
524 |
$12K |
| V2020 |
Frames, purchases |
978 |
978 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
51 |
51 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
701 |
701 |
$0.00 |