| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
416 |
375 |
$18K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
375 |
353 |
$10K |
| 92015 |
Determination of refractive state |
550 |
506 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
369 |
323 |
$8K |
| V2020 |
Frames, purchases |
502 |
441 |
$7K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
20 |
15 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
81 |
79 |
$717.34 |