| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
167 |
164 |
$15K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
240 |
236 |
$10K |
| V2020 |
Frames, purchases |
293 |
284 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
445 |
427 |
$4K |
| V2025 |
Deluxe frame |
66 |
66 |
$4K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
14 |
14 |
$1K |
| 92015 |
Determination of refractive state |
78 |
72 |
$181.65 |