| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
29 |
29 |
$995.00 |
| 92015 |
Determination of refractive state |
116 |
116 |
$784.00 |
| V2020 |
Frames, purchases |
241 |
230 |
$30.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
157 |
149 |
$4.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
180 |
173 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
68 |
68 |
$0.00 |