| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
401 |
390 |
$31K |
| V2020 |
Frames, purchases |
670 |
632 |
$19K |
| 92015 |
Determination of refractive state |
784 |
767 |
$17K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
384 |
366 |
$11K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
169 |
167 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
337 |
318 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
618 |
586 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
14 |
14 |
$210.00 |