| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
576 |
575 |
$25K |
| 92015 |
Determination of refractive state |
1,016 |
1,013 |
$17K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
351 |
350 |
$16K |
| V2025 |
Deluxe frame |
106 |
106 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
113 |
113 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
130 |
125 |
$2K |
| V2020 |
Frames, purchases |
108 |
102 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
102 |
102 |
$760.00 |
| 92250 |
|
15 |
14 |
$620.50 |