| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,497 |
3,497 |
$381K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
3,214 |
3,212 |
$96K |
| 92015 |
Determination of refractive state |
4,716 |
4,715 |
$84K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,208 |
2,202 |
$54K |
| V2020 |
Frames, purchases |
3,499 |
3,492 |
$35K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
262 |
262 |
$34K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
28 |
28 |
$571.95 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
15 |
15 |
$320.85 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,447 |
3,441 |
$0.00 |