| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
66 |
59 |
$3K |
| 92015 |
Determination of refractive state |
110 |
95 |
$491.40 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
21 |
15 |
$450.00 |
| V2020 |
Frames, purchases |
20 |
14 |
$280.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
18 |
12 |
$220.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
17 |
17 |
$90.09 |