| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
570 |
565 |
$11K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
488 |
480 |
$10K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
67 |
63 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$590.28 |
| V2020 |
Frames, purchases |
604 |
594 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
543 |
537 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
127 |
125 |
$0.00 |