| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,386 |
1,374 |
$80K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
425 |
424 |
$53K |
| 92015 |
Determination of refractive state |
238 |
237 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
15 |
15 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
41 |
41 |
$165.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
37 |
37 |
$65.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
14 |
14 |
$0.00 |