| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
102 |
101 |
$11K |
| V2020 |
Frames, purchases |
353 |
339 |
$11K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
246 |
234 |
$8K |
| 92015 |
Determination of refractive state |
561 |
541 |
$8K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
328 |
320 |
$7K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
15 |
15 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$390.72 |