| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
381 |
378 |
$18K |
| 92015 |
Determination of refractive state |
707 |
698 |
$10K |
| V2020 |
Frames, purchases |
250 |
241 |
$6K |
| 92002 |
|
91 |
90 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
15 |
15 |
$432.28 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
18 |
17 |
$422.28 |
| V2756 |
Eye glass case |
167 |
161 |
$163.08 |