| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,308 |
657 |
$32K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
976 |
445 |
$29K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
369 |
203 |
$24K |
| V2020 |
Frames, purchases |
1,211 |
572 |
$14K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
762 |
331 |
$13K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
72 |
64 |
$4K |
| 92015 |
Determination of refractive state |
51 |
48 |
$587.23 |
| 1036F |
|
43 |
42 |
$0.00 |
| G9903 |
Patient screened for tobacco use and identified as a tobacco non-user |
43 |
42 |
$0.00 |