| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
782 |
646 |
$23K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
359 |
266 |
$17K |
| V2020 |
Frames, purchases |
382 |
318 |
$9K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
160 |
157 |
$7K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
240 |
226 |
$5K |
| 92250 |
|
27 |
27 |
$974.33 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
48 |
31 |
$789.75 |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
35 |
16 |
$445.48 |