| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
203 |
203 |
$14K |
| 92015 |
Determination of refractive state |
989 |
983 |
$14K |
| 92250 |
|
401 |
401 |
$14K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
203 |
202 |
$13K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
804 |
801 |
$13K |
| V2020 |
Frames, purchases |
297 |
296 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
293 |
293 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
118 |
118 |
$2K |