| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
245 |
228 |
$3K |
| 92015 |
Determination of refractive state |
449 |
435 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
91 |
89 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
40 |
40 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
24 |
24 |
$515.52 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
25 |
24 |
$511.59 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
12 |
$52.00 |