| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
147 |
135 |
$11K |
| V2020 |
Frames, purchases |
308 |
251 |
$8K |
| 92015 |
Determination of refractive state |
314 |
291 |
$7K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
108 |
108 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
230 |
184 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
166 |
133 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
267 |
229 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
15 |
14 |
$139.20 |
| V2755 |
U-v lens, per lens |
27 |
12 |
$0.00 |