| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
173 |
173 |
$19K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
675 |
669 |
$19K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
151 |
151 |
$19K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
541 |
539 |
$16K |
| 92015 |
Determination of refractive state |
888 |
888 |
$16K |
| V2020 |
Frames, purchases |
574 |
570 |
$6K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
12 |
12 |
$895.20 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
676 |
670 |
$0.00 |