| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
254 |
229 |
$21K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
94 |
89 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
74 |
74 |
$5K |
| 92015 |
Determination of refractive state |
228 |
208 |
$888.14 |
| V2020 |
Frames, purchases |
37 |
28 |
$45.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
12 |
$18.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
18 |
14 |
$6.00 |