| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,517 |
1,517 |
$87K |
| V2020 |
Frames, purchases |
463 |
462 |
$20K |
| V2199 |
Not otherwise classified, single vision lens |
380 |
379 |
$19K |
| 92015 |
Determination of refractive state |
2,067 |
2,067 |
$17K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
243 |
243 |
$13K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
463 |
462 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
153 |
153 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
43 |
43 |
$602.00 |