| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
86 |
86 |
$5K |
| V2020 |
Frames, purchases |
146 |
140 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
110 |
104 |
$985.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
29 |
29 |
$721.52 |
| 92285 |
|
13 |
13 |
$509.99 |
| 92250 |
|
12 |
12 |
$479.60 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
15 |
12 |
$295.00 |