| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
115 |
113 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
431 |
431 |
$1K |
| 92015 |
Determination of refractive state |
169 |
169 |
$523.60 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
232 |
232 |
$500.40 |
| V2020 |
Frames, purchases |
667 |
653 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
26 |
13 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
29 |
29 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
24 |
12 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
629 |
321 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
544 |
290 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
83 |
83 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
25 |
15 |
$0.00 |