| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
556 |
555 |
$51K |
| 92015 |
Determination of refractive state |
510 |
510 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
53 |
53 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
41 |
41 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
53 |
53 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
63 |
62 |
$682.66 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
13 |
$572.00 |