| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
167 |
167 |
$11K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
112 |
112 |
$10K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
179 |
178 |
$6K |
| V2020 |
Frames, purchases |
183 |
182 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
168 |
128 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
131 |
129 |
$1K |
| V2760 |
Scratch resistant coating, per lens |
142 |
129 |
$272.00 |
| 92015 |
Determination of refractive state |
273 |
273 |
$20.22 |