| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
221 |
199 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
132 |
127 |
$6K |
| 92015 |
Determination of refractive state |
298 |
271 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
155 |
147 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
64 |
62 |
$3K |
| 92341 |
|
58 |
45 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
30 |
30 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
53 |
51 |
$669.50 |
| V2102 |
Sphere, single vision, plus or minus 7.12 to plus or minus 20.00d, per lens |
30 |
29 |
$390.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
56 |
55 |
$350.56 |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
16 |
14 |
$208.00 |