| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
132 |
108 |
$10K |
| V2020 |
Frames, purchases |
159 |
123 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
119 |
93 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
50 |
45 |
$444.45 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
12 |
$183.35 |
| 92015 |
Determination of refractive state |
212 |
163 |
$0.00 |