| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
78 |
78 |
$3K |
| 92015 |
Determination of refractive state |
226 |
222 |
$2K |
| V2020 |
Frames, purchases |
70 |
70 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
44 |
44 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
43 |
42 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
37 |
36 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
38 |
38 |
$769.12 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
42 |
42 |
$540.12 |