| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
923 |
923 |
$58K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
689 |
689 |
$45K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,174 |
1,169 |
$44K |
| V2020 |
Frames, purchases |
1,384 |
1,380 |
$26K |
| 92015 |
Determination of refractive state |
1,422 |
1,422 |
$9K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
461 |
461 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
330 |
329 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
60 |
60 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
90 |
90 |
$881.60 |