| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
489 |
461 |
$23K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
396 |
346 |
$16K |
| 92015 |
Determination of refractive state |
1,035 |
949 |
$5K |
| V2020 |
Frames, purchases |
180 |
139 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
245 |
245 |
$465.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
35 |
25 |
$449.86 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
41 |
26 |
$426.44 |