| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
35 |
35 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
48 |
48 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
48 |
48 |
$850.00 |
| V2020 |
Frames, purchases |
55 |
55 |
$787.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
15 |
15 |
$740.45 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
17 |
17 |
$170.00 |