| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
879 |
878 |
$61K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
751 |
751 |
$49K |
| 92015 |
Determination of refractive state |
1,972 |
1,971 |
$18K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
138 |
137 |
$15K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
408 |
408 |
$8K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
101 |
101 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
60 |
60 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$783.00 |
| V2020 |
Frames, purchases |
12 |
12 |
$236.50 |