| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
321 |
321 |
$30K |
| 92015 |
Determination of refractive state |
833 |
833 |
$15K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
245 |
244 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
44 |
44 |
$6K |
| V2020 |
Frames, purchases |
302 |
301 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
105 |
105 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
38 |
38 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
364 |
363 |
$0.00 |