| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
546 |
535 |
$8K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
213 |
208 |
$8K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
379 |
371 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
24 |
24 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
145 |
85 |
$880.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
24 |
12 |
$275.00 |
| 92015 |
Determination of refractive state |
729 |
714 |
$122.70 |