| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
163 |
163 |
$20K |
| V2020 |
Frames, purchases |
538 |
538 |
$18K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
133 |
133 |
$15K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
563 |
561 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
161 |
155 |
$6K |
| V2025 |
Deluxe frame |
141 |
140 |
$3K |
| 92015 |
Determination of refractive state |
276 |
274 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
118 |
106 |
$1K |