| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
306 |
300 |
$30K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,988 |
1,965 |
$29K |
| V2025 |
Deluxe frame |
577 |
575 |
$26K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
129 |
123 |
$12K |
| 92015 |
Determination of refractive state |
434 |
422 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
512 |
434 |
$7K |
| V2020 |
Frames, purchases |
804 |
781 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
663 |
622 |
$560.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
431 |
423 |
$197.50 |