| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,363 |
2,298 |
$111K |
| 92250 |
|
2,488 |
2,412 |
$96K |
| 92015 |
Determination of refractive state |
2,836 |
2,760 |
$81K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,488 |
1,449 |
$75K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
954 |
936 |
$63K |
| S0512 |
Daily wear specialty contact lens, per lens |
235 |
213 |
$58K |
| S0592 |
Comprehensive contact lens evaluation |
218 |
194 |
$11K |
| 99215 |
Prolong outpt/office vis |
12 |
12 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
28 |
28 |
$708.22 |
| V2020 |
Frames, purchases |
28 |
28 |
$575.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
14 |
14 |
$84.00 |