| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
103 |
103 |
$8K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
310 |
308 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
132 |
65 |
$3K |
| 92015 |
Determination of refractive state |
85 |
85 |
$2K |
| V2020 |
Frames, purchases |
43 |
42 |
$485.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
184 |
91 |
$90.00 |
| 3072F |
|
27 |
27 |
$0.00 |
| V2755 |
U-v lens, per lens |
24 |
12 |
$0.00 |