| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
299 |
231 |
$23K |
| V2020 |
Frames, purchases |
775 |
587 |
$11K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
100 |
84 |
$9K |
| 92015 |
Determination of refractive state |
659 |
519 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
45 |
38 |
$630.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
424 |
308 |
$531.67 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
611 |
273 |
$481.11 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
12 |
$0.00 |