| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
99 |
98 |
$4K |
| V2020 |
Frames, purchases |
108 |
105 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
91 |
87 |
$3K |
| 92015 |
Determination of refractive state |
204 |
199 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
87 |
87 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
97 |
95 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
82 |
80 |
$1K |