| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
354 |
347 |
$16K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
89 |
89 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
33 |
32 |
$977.40 |
| V2020 |
Frames, purchases |
33 |
32 |
$620.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
33 |
32 |
$372.00 |
| 92015 |
Determination of refractive state |
69 |
62 |
$245.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
15 |
14 |
$225.00 |