| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
189 |
171 |
$6K |
| 92015 |
Determination of refractive state |
240 |
202 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
100 |
88 |
$5K |
| V2020 |
Frames, purchases |
267 |
261 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
232 |
218 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
126 |
88 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
154 |
100 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
51 |
51 |
$2K |
| 92025 |
|
46 |
46 |
$559.82 |