| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
1,041 |
1,010 |
$12K |
| V2020 |
Frames, purchases |
359 |
341 |
$11K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
149 |
147 |
$8K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
225 |
215 |
$4K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
86 |
86 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
40 |
39 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
28 |
27 |
$540.00 |