| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
179 |
170 |
$17K |
| V2020 |
Frames, purchases |
324 |
300 |
$9K |
| 92015 |
Determination of refractive state |
398 |
373 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
40 |
39 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
124 |
124 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
27 |
27 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
14 |
14 |
$293.04 |