| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
148 |
142 |
$17K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
74 |
74 |
$12K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
111 |
110 |
$11K |
| V2020 |
Frames, purchases |
74 |
72 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
90 |
87 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
40 |
39 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
56 |
55 |
$1K |
| 92015 |
Determination of refractive state |
391 |
382 |
$101.70 |