| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
361 |
341 |
$21K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
366 |
343 |
$9K |
| 92015 |
Determination of refractive state |
640 |
615 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
34 |
34 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
109 |
103 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
20 |
18 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
29 |
29 |
$942.54 |
| V2756 |
Eye glass case |
617 |
591 |
$854.22 |
| V2025 |
Deluxe frame |
44 |
44 |
$0.00 |