| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
134 |
124 |
$9K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
246 |
238 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
70 |
69 |
$7K |
| V2020 |
Frames, purchases |
221 |
208 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
110 |
61 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
86 |
59 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
173 |
162 |
$1K |
| 92015 |
Determination of refractive state |
133 |
122 |
$121.32 |