| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
347 |
333 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
304 |
291 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
58 |
56 |
$4K |
| 92015 |
Determination of refractive state |
336 |
322 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
24 |
24 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
44 |
25 |
$417.19 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
44 |
25 |
$335.40 |