| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
298 |
296 |
$15K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
220 |
216 |
$10K |
| 92015 |
Determination of refractive state |
599 |
590 |
$10K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
156 |
156 |
$5K |
| V2020 |
Frames, purchases |
163 |
162 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
60 |
58 |
$939.79 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
81 |
81 |
$931.00 |