| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
131 |
131 |
$6K |
| 92015 |
Determination of refractive state |
188 |
188 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
81 |
81 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
112 |
112 |
$2K |
| V2020 |
Frames, purchases |
264 |
260 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
252 |
250 |
$778.33 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
30 |
30 |
$527.41 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
60 |
60 |
$0.00 |