| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
669 |
666 |
$42K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,400 |
1,388 |
$23K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
282 |
280 |
$20K |
| 92015 |
Determination of refractive state |
1,336 |
1,329 |
$18K |
| V2020 |
Frames, purchases |
229 |
229 |
$9K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
229 |
229 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
58 |
58 |
$731.48 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$126.00 |