| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
83 |
83 |
$11K |
| V2020 |
Frames, purchases |
146 |
146 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
161 |
161 |
$7K |
| 92015 |
Determination of refractive state |
279 |
272 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
42 |
42 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
18 |
12 |
$568.22 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
15 |
14 |
$415.87 |