| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
775 |
766 |
$34K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
116 |
114 |
$5K |
| V2020 |
Frames, purchases |
205 |
201 |
$1K |
| 92015 |
Determination of refractive state |
1,121 |
1,107 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
59 |
59 |
$531.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
16 |
16 |
$325.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$120.00 |
| V2025 |
Deluxe frame |
25 |
25 |
$0.00 |