| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
97 |
96 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
148 |
85 |
$4K |
| V2025 |
Deluxe frame |
57 |
51 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
102 |
97 |
$2K |
| 92015 |
Determination of refractive state |
242 |
178 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
75 |
70 |
$5.00 |
| V2020 |
Frames, purchases |
14 |
14 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
50 |
50 |
$0.00 |