| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
599 |
593 |
$19K |
| 92015 |
Determination of refractive state |
452 |
449 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
226 |
226 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
56 |
55 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
33 |
33 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
187 |
109 |
$1K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
24 |
24 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
28 |
14 |
$0.00 |
| V2702 |
Deluxe lens feature |
12 |
12 |
$0.00 |