| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
231 |
219 |
$10K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
110 |
107 |
$5K |
| 92015 |
Determination of refractive state |
315 |
315 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
111 |
111 |
$3K |
| V2020 |
Frames, purchases |
41 |
41 |
$910.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
17 |
17 |
$280.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
13 |
$192.50 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
15 |
15 |
$100.00 |