| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
683 |
636 |
$31K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
543 |
510 |
$28K |
| 92015 |
Determination of refractive state |
1,165 |
1,002 |
$18K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
226 |
221 |
$13K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
225 |
222 |
$6K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
143 |
103 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
261 |
254 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
44 |
44 |
$3K |
| 92002 |
|
29 |
27 |
$1K |
| V2756 |
Eye glass case |
682 |
637 |
$784.67 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
12 |
12 |
$0.00 |