| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
916 |
780 |
$16K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
210 |
179 |
$13K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
172 |
148 |
$8K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
107 |
102 |
$3K |
| V2020 |
Frames, purchases |
223 |
214 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
227 |
216 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
60 |
56 |
$733.26 |