| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
656 |
614 |
$14K |
| V2020 |
Frames, purchases |
617 |
581 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
190 |
188 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
259 |
169 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
284 |
186 |
$2K |
| 92015 |
Determination of refractive state |
596 |
553 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
48 |
30 |
$845.88 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
29 |
29 |
$20.00 |