| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
327 |
327 |
$23K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
269 |
269 |
$17K |
| 92015 |
Determination of refractive state |
803 |
802 |
$9K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
265 |
265 |
$5K |
| V2020 |
Frames, purchases |
161 |
161 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
44 |
44 |
$616.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
153 |
153 |
$538.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$168.00 |