| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
226 |
226 |
$16K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
149 |
148 |
$15K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
222 |
213 |
$7K |
| V2020 |
Frames, purchases |
283 |
254 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
272 |
250 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
56 |
49 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
40 |
38 |
$926.10 |
| 92015 |
Determination of refractive state |
507 |
503 |
$889.68 |