| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
356 |
349 |
$23K |
| 92250 |
|
605 |
596 |
$21K |
| 92015 |
Determination of refractive state |
752 |
740 |
$12K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
750 |
742 |
$10K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
90 |
88 |
$7K |
| V2020 |
Frames, purchases |
13 |
13 |
$242.50 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$181.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
13 |
$161.00 |