| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
165 |
161 |
$14K |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
119 |
113 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
49 |
49 |
$4K |
| 92015 |
Determination of refractive state |
231 |
228 |
$4K |
| 92250 |
|
111 |
110 |
$4K |
| V2020 |
Frames, purchases |
170 |
166 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
167 |
163 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
112 |
107 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
26 |
24 |
$231.42 |