| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
251 |
246 |
$13K |
| 92015 |
Determination of refractive state |
311 |
305 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
289 |
284 |
$7K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
163 |
161 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
262 |
260 |
$4K |
| V2020 |
Frames, purchases |
263 |
260 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
27 |
27 |
$472.04 |