| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
131 |
131 |
$6K |
| V2020 |
Frames, purchases |
444 |
441 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
107 |
106 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
48 |
46 |
$1K |
| 92015 |
Determination of refractive state |
82 |
82 |
$972.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
96 |
49 |
$469.88 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
113 |
59 |
$302.96 |
| V2755 |
U-v lens, per lens |
84 |
42 |
$0.00 |