| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
56 |
54 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
71 |
67 |
$561.16 |
| V2020 |
Frames, purchases |
110 |
104 |
$418.72 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
53 |
51 |
$166.54 |
| 92015 |
Determination of refractive state |
143 |
134 |
$0.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
108 |
103 |
$0.00 |