| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
916 |
892 |
$36K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
748 |
722 |
$27K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
870 |
849 |
$17K |
| V2020 |
Frames, purchases |
723 |
694 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
515 |
486 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
211 |
196 |
$989.00 |
| S0500 |
Disposable contact lens, per lens |
12 |
12 |
$908.00 |
| 92015 |
Determination of refractive state |
27 |
27 |
$156.00 |