| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
97 |
97 |
$4K |
| V2020 |
Frames, purchases |
177 |
176 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
113 |
112 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
59 |
58 |
$2K |
| 92015 |
Determination of refractive state |
345 |
338 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
52 |
51 |
$892.57 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
14 |
14 |
$156.00 |