| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
175 |
144 |
$13K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
210 |
170 |
$9K |
| V2020 |
Frames, purchases |
522 |
418 |
$8K |
| 92015 |
Determination of refractive state |
621 |
478 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
128 |
103 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
29 |
25 |
$410.40 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
13 |
13 |
$247.92 |