| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
192 |
178 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
155 |
153 |
$8K |
| V2020 |
Frames, purchases |
194 |
171 |
$7K |
| 92015 |
Determination of refractive state |
528 |
525 |
$7K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
81 |
76 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
106 |
88 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
142 |
121 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
71 |
53 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
22 |
22 |
$242.44 |