| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
621 |
608 |
$26K |
| V2020 |
Frames, purchases |
611 |
611 |
$24K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
810 |
792 |
$18K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
374 |
372 |
$16K |
| 92015 |
Determination of refractive state |
1,121 |
1,100 |
$14K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
614 |
614 |
$8K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
308 |
308 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
73 |
73 |
$791.12 |