| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
261 |
261 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
45 |
45 |
$680.00 |
| 92015 |
Determination of refractive state |
91 |
91 |
$303.60 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
167 |
167 |
$273.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
272 |
136 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
226 |
109 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
140 |
70 |
$0.00 |
| V2020 |
Frames, purchases |
339 |
328 |
$0.00 |