| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
461 |
460 |
$20K |
| 92015 |
Determination of refractive state |
767 |
765 |
$11K |
| V2020 |
Frames, purchases |
226 |
226 |
$9K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
106 |
106 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
88 |
88 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
160 |
160 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
80 |
80 |
$867.68 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$115.80 |