| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
743 |
685 |
$46K |
| V2020 |
Frames, purchases |
769 |
740 |
$18K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
634 |
611 |
$12K |
| 92015 |
Determination of refractive state |
583 |
565 |
$9K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
339 |
308 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$913.44 |
| 92002 |
|
15 |
15 |
$622.53 |
| V2756 |
Eye glass case |
526 |
502 |
$509.12 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$98.40 |