| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
105 |
102 |
$4K |
| V2020 |
Frames, purchases |
107 |
101 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
84 |
78 |
$3K |
| 92015 |
Determination of refractive state |
268 |
257 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
63 |
63 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
88 |
82 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
89 |
83 |
$1K |