| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
933 |
907 |
$39K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,236 |
1,206 |
$26K |
| 92015 |
Determination of refractive state |
1,667 |
1,612 |
$20K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
405 |
398 |
$18K |
| V2020 |
Frames, purchases |
1,197 |
1,170 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
83 |
83 |
$1K |
| 92250 |
|
25 |
25 |
$643.23 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
928 |
905 |
$592.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
440 |
427 |
$60.80 |