| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
368 |
290 |
$15K |
| 92015 |
Determination of refractive state |
491 |
397 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
107 |
59 |
$2K |
| V2020 |
Frames, purchases |
119 |
70 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
130 |
127 |
$810.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$238.14 |