| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
470 |
429 |
$20K |
| 92015 |
Determination of refractive state |
880 |
807 |
$11K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
252 |
230 |
$9K |
| 92250 |
|
104 |
94 |
$3K |
| V2020 |
Frames, purchases |
55 |
54 |
$744.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
38 |
38 |
$684.32 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
20 |
20 |
$436.08 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
18 |
18 |
$115.00 |