| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,347 |
1,347 |
$146K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
597 |
597 |
$76K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,515 |
1,514 |
$46K |
| 92015 |
Determination of refractive state |
1,642 |
1,641 |
$29K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,002 |
1,001 |
$24K |
| V2020 |
Frames, purchases |
1,490 |
1,489 |
$15K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
293 |
292 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
57 |
57 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,530 |
1,528 |
$0.00 |