| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
190 |
189 |
$8K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
148 |
148 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
295 |
295 |
$4K |
| V2020 |
Frames, purchases |
433 |
431 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
250 |
125 |
$2K |
| 92015 |
Determination of refractive state |
199 |
198 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
60 |
30 |
$698.36 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
668 |
334 |
$0.00 |