| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
106 |
105 |
$12K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
16 |
14 |
$519.50 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
213 |
206 |
$185.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
25 |
12 |
$77.00 |
| V2020 |
Frames, purchases |
165 |
159 |
$56.00 |
| 92015 |
Determination of refractive state |
209 |
205 |
$27.16 |