| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
166 |
156 |
$17K |
| V2020 |
Frames, purchases |
231 |
224 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
163 |
154 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
209 |
119 |
$2K |
| 92015 |
Determination of refractive state |
232 |
219 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
47 |
26 |
$479.52 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
137 |
112 |
$2.18 |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
68 |
49 |
$0.00 |