| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
1,264 |
1,137 |
$69K |
| V2020 |
Frames, purchases |
1,399 |
1,354 |
$49K |
| 92015 |
Determination of refractive state |
3,282 |
3,119 |
$46K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
858 |
847 |
$39K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
714 |
636 |
$32K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
253 |
240 |
$16K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
594 |
359 |
$11K |
| 92341 |
|
54 |
50 |
$2K |
| V2756 |
Eye glass case |
1,263 |
1,224 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
29 |
29 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
144 |
139 |
$782.40 |
| V2702 |
Deluxe lens feature |
16 |
14 |
$0.00 |