| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
370 |
370 |
$26K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
624 |
620 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
202 |
101 |
$3K |
| V2020 |
Frames, purchases |
231 |
231 |
$1K |
| 92015 |
Determination of refractive state |
67 |
67 |
$919.60 |
| V2199 |
Not otherwise classified, single vision lens |
150 |
75 |
$862.68 |
| 3072F |
|
42 |
42 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
122 |
61 |
$0.00 |