| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
272 |
263 |
$16K |
| V2020 |
Frames, purchases |
295 |
193 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
84 |
84 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
273 |
181 |
$468.40 |
| 92015 |
Determination of refractive state |
443 |
431 |
$55.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
279 |
186 |
$19.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
38 |
38 |
$0.00 |