| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
750 |
740 |
$82K |
| V2020 |
Frames, purchases |
818 |
802 |
$54K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
779 |
753 |
$46K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
386 |
374 |
$37K |
| 92015 |
Determination of refractive state |
2,122 |
2,069 |
$28K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
408 |
398 |
$26K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
811 |
796 |
$24K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$866.76 |