| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
423 |
371 |
$9K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
209 |
201 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
46 |
38 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
74 |
53 |
$2K |
| V2020 |
Frames, purchases |
125 |
109 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
38 |
29 |
$905.50 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
15 |
14 |
$670.67 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
26 |
26 |
$218.14 |