| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
811 |
754 |
$48K |
| V2020 |
Frames, purchases |
983 |
931 |
$32K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
402 |
360 |
$26K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
436 |
403 |
$8K |
| 92015 |
Determination of refractive state |
802 |
751 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
97 |
86 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
209 |
183 |
$2K |
| V2025 |
Deluxe frame |
57 |
56 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
32 |
28 |
$258.89 |