| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
622 |
613 |
$28K |
| 92015 |
Determination of refractive state |
1,766 |
1,678 |
$28K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
497 |
492 |
$24K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
265 |
263 |
$18K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
405 |
400 |
$13K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
188 |
186 |
$11K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
113 |
109 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
101 |
100 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
27 |
27 |
$2K |
| 92341 |
|
14 |
14 |
$599.91 |
| 92002 |
|
13 |
13 |
$423.95 |
| V2756 |
Eye glass case |
350 |
342 |
$379.95 |