| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
249 |
203 |
$7K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
153 |
115 |
$5K |
| V2020 |
Frames, purchases |
189 |
179 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
132 |
126 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
31 |
25 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
39 |
38 |
$972.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
38 |
38 |
$912.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
34 |
34 |
$806.50 |
| 92341 |
|
14 |
14 |
$261.52 |