| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
296 |
265 |
$9K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
44 |
44 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
32 |
31 |
$2K |
| 92015 |
Determination of refractive state |
310 |
280 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
192 |
175 |
$810.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
36 |
30 |
$280.14 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
50 |
42 |
$70.00 |