| Code | Description | Claims | Beneficiaries | Total Paid |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
444 |
438 |
$8K |
| 92015 |
Determination of refractive state |
477 |
463 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
51 |
49 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
17 |
17 |
$1K |
| V2020 |
Frames, purchases |
243 |
241 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
210 |
210 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$0.00 |