| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
377 |
377 |
$17K |
| 92015 |
Determination of refractive state |
644 |
644 |
$13K |
| V2020 |
Frames, purchases |
528 |
527 |
$11K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
439 |
437 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
263 |
253 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
113 |
113 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
413 |
413 |
$4K |
| V2760 |
Scratch resistant coating, per lens |
133 |
133 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
60 |
60 |
$897.00 |