| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
144 |
129 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
84 |
68 |
$4K |
| V2020 |
Frames, purchases |
145 |
122 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
45 |
41 |
$1K |
| 92015 |
Determination of refractive state |
393 |
358 |
$953.75 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
294 |
265 |
$756.10 |
| V2025 |
Deluxe frame |
58 |
54 |
$0.00 |