| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,376 |
2,372 |
$76K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,904 |
1,902 |
$38K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
420 |
420 |
$30K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
233 |
233 |
$20K |
| 92015 |
Determination of refractive state |
1,208 |
1,205 |
$14K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,242 |
1,239 |
$13K |
| 92250 |
|
428 |
428 |
$10K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
37 |
37 |
$2K |
| 92341 |
|
38 |
38 |
$867.04 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
93 |
93 |
$705.32 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
14 |
14 |
$193.25 |