| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
179 |
179 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
134 |
134 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
40 |
40 |
$560.00 |
| 92015 |
Determination of refractive state |
67 |
67 |
$198.00 |
| V2020 |
Frames, purchases |
158 |
158 |
$20.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
90 |
45 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
174 |
87 |
$0.00 |