| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
165 |
158 |
$12K |
| V2020 |
Frames, purchases |
205 |
191 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
171 |
96 |
$429.30 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
65 |
58 |
$74.36 |
| 92015 |
Determination of refractive state |
290 |
263 |
$0.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
16 |
13 |
$0.00 |