| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
491 |
448 |
$28K |
| V2020 |
Frames, purchases |
842 |
663 |
$21K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
177 |
156 |
$11K |
| 92015 |
Determination of refractive state |
949 |
864 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
740 |
585 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
704 |
554 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
58 |
53 |
$120.00 |