| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
432 |
397 |
$9K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
168 |
158 |
$9K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
171 |
165 |
$7K |
| V2020 |
Frames, purchases |
295 |
264 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
194 |
173 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
80 |
42 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
41 |
36 |
$880.12 |
| 92370 |
|
16 |
13 |
$110.00 |