| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
387 |
373 |
$44K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
151 |
145 |
$14K |
| V2020 |
Frames, purchases |
410 |
388 |
$14K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
71 |
67 |
$9K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
189 |
180 |
$7K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
410 |
390 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
399 |
379 |
$5K |
| 92015 |
Determination of refractive state |
713 |
680 |
$979.40 |