| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,355 |
1,341 |
$38K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,233 |
1,214 |
$24K |
| 92250 |
|
781 |
767 |
$15K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
494 |
482 |
$6K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
76 |
72 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
63 |
62 |
$3K |
| 92015 |
Determination of refractive state |
332 |
325 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$957.99 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
13 |
13 |
$882.00 |
| 92341 |
|
25 |
25 |
$551.52 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
12 |
12 |
$18.00 |