| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
309 |
298 |
$20K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
360 |
357 |
$16K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
205 |
203 |
$9K |
| V2020 |
Frames, purchases |
376 |
366 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
34 |
25 |
$688.16 |
| 92015 |
Determination of refractive state |
56 |
56 |
$585.35 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
37 |
26 |
$475.82 |