| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
280 |
272 |
$25K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
363 |
356 |
$25K |
| V2020 |
Frames, purchases |
325 |
323 |
$10K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
276 |
274 |
$9K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
237 |
181 |
$3K |
| 92015 |
Determination of refractive state |
644 |
629 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
176 |
175 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
43 |
27 |
$420.48 |