| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
184 |
166 |
$9K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
57 |
56 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
59 |
56 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
157 |
138 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
145 |
126 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$1K |
| 92015 |
Determination of refractive state |
672 |
633 |
$490.97 |