| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
750 |
738 |
$19K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
680 |
668 |
$18K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
263 |
263 |
$17K |
| V2020 |
Frames, purchases |
942 |
926 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
230 |
193 |
$910.36 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$906.81 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
495 |
486 |
$106.74 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
75 |
69 |
$105.34 |