| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
422 |
417 |
$31K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
136 |
136 |
$11K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
500 |
496 |
$10K |
| 92015 |
Determination of refractive state |
727 |
724 |
$9K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
105 |
105 |
$3K |
| V2020 |
Frames, purchases |
45 |
45 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
16 |
16 |
$184.96 |