| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
461 |
461 |
$39K |
| 92015 |
Determination of refractive state |
998 |
997 |
$25K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
87 |
87 |
$9K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
215 |
214 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
190 |
189 |
$3K |
| V2020 |
Frames, purchases |
195 |
194 |
$2K |
| V2760 |
Scratch resistant coating, per lens |
194 |
193 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
195 |
194 |
$1K |