| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
404 |
404 |
$42K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
600 |
591 |
$18K |
| 92015 |
Determination of refractive state |
644 |
643 |
$11K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
304 |
297 |
$7K |
| V2020 |
Frames, purchases |
704 |
694 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
54 |
54 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
41 |
40 |
$739.35 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
12 |
12 |
$0.00 |