| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
366 |
366 |
$48K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
367 |
367 |
$39K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
696 |
696 |
$21K |
| 92015 |
Determination of refractive state |
1,037 |
1,037 |
$18K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
393 |
393 |
$11K |
| V2020 |
Frames, purchases |
628 |
628 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
59 |
59 |
$2K |