| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
606 |
590 |
$20K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
259 |
255 |
$18K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
390 |
377 |
$12K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
96 |
86 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
39 |
36 |
$3K |
| V2020 |
Frames, purchases |
102 |
92 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
41 |
37 |
$776.58 |