| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
926 |
804 |
$26K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
183 |
159 |
$8K |
| 92250 |
|
272 |
236 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
126 |
110 |
$8K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
354 |
329 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
117 |
108 |
$3K |
| V2020 |
Frames, purchases |
321 |
297 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
179 |
138 |
$843.24 |