| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
455 |
436 |
$16K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
416 |
407 |
$12K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
168 |
162 |
$11K |
| 92250 |
|
330 |
311 |
$11K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
176 |
173 |
$10K |
| V2020 |
Frames, purchases |
505 |
490 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
499 |
334 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
74 |
73 |
$120.00 |