| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
853 |
848 |
$74K |
| V2020 |
Frames, purchases |
510 |
509 |
$15K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
371 |
371 |
$12K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
119 |
119 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
98 |
98 |
$475.00 |
| 92015 |
Determination of refractive state |
25 |
25 |
$150.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$127.68 |