| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
335 |
334 |
$14K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
569 |
559 |
$11K |
| 92015 |
Determination of refractive state |
573 |
570 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
96 |
95 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
131 |
131 |
$4K |
| V2020 |
Frames, purchases |
96 |
96 |
$1K |
| 92341 |
|
43 |
42 |
$995.97 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
19 |
19 |
$456.00 |
| 92250 |
|
13 |
13 |
$208.36 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
25 |
20 |
$84.00 |