| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
352 |
347 |
$7K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
267 |
260 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
117 |
111 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
25 |
25 |
$1K |
| V2020 |
Frames, purchases |
351 |
338 |
$180.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
342 |
328 |
$39.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
182 |
176 |
$0.00 |