| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
288 |
283 |
$18K |
| V2020 |
Frames, purchases |
410 |
382 |
$12K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
86 |
86 |
$5K |
| 92015 |
Determination of refractive state |
526 |
521 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
391 |
365 |
$2K |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
28 |
28 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
346 |
320 |
$1K |
| 92250 |
|
29 |
29 |
$910.76 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
23 |
23 |
$243.60 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
12 |
12 |
$0.00 |