| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
208 |
189 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
120 |
109 |
$5K |
| 92015 |
Determination of refractive state |
305 |
288 |
$3K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
60 |
60 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
108 |
99 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
159 |
141 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
31 |
27 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
56 |
56 |
$1K |