| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
155 |
152 |
$6K |
| 92015 |
Determination of refractive state |
140 |
139 |
$3K |
| V2020 |
Frames, purchases |
181 |
174 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
121 |
119 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
13 |
13 |
$826.02 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
17 |
12 |
$739.50 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
13 |
$495.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
13 |
$244.60 |