| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
124 |
117 |
$11K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
107 |
87 |
$8K |
| V2020 |
Frames, purchases |
219 |
201 |
$7K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
192 |
181 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
71 |
43 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
221 |
107 |
$1K |
| 92015 |
Determination of refractive state |
329 |
304 |
$87.70 |