| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
139 |
139 |
$13K |
| V2020 |
Frames, purchases |
105 |
105 |
$8K |
| 92015 |
Determination of refractive state |
378 |
374 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
106 |
105 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
33 |
33 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
24 |
24 |
$767.76 |
| 92370 |
|
12 |
12 |
$340.68 |