| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
928 |
899 |
$33K |
| 92015 |
Determination of refractive state |
1,217 |
1,174 |
$11K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
355 |
347 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
34 |
33 |
$2K |
| V2020 |
Frames, purchases |
111 |
111 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$298.56 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
25 |
25 |
$59.00 |