| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,690 |
3,665 |
$298K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,561 |
2,533 |
$186K |
| 92015 |
Determination of refractive state |
6,282 |
6,224 |
$92K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
3,766 |
3,728 |
$77K |
| V2020 |
Frames, purchases |
183 |
180 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
292 |
159 |
$2K |
| V2760 |
Scratch resistant coating, per lens |
90 |
90 |
$895.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
12 |
12 |
$300.00 |