| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
111 |
108 |
$6K |
| 92015 |
Determination of refractive state |
342 |
334 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
65 |
64 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
146 |
146 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
183 |
143 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
84 |
78 |
$1K |
| V2020 |
Frames, purchases |
62 |
62 |
$620.00 |