| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
557 |
527 |
$49K |
| V2020 |
Frames, purchases |
133 |
111 |
$7K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
86 |
82 |
$5K |
| 92015 |
Determination of refractive state |
1,268 |
1,213 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
36 |
19 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
102 |
100 |
$570.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
22 |
12 |
$249.48 |