| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
95 |
91 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
27 |
27 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
74 |
71 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
19 |
18 |
$2K |
| 92015 |
Determination of refractive state |
85 |
79 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
34 |
16 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
24 |
12 |
$864.11 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
27 |
15 |
$715.94 |