| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
309 |
308 |
$19K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
369 |
362 |
$17K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
185 |
184 |
$8K |
| V2020 |
Frames, purchases |
357 |
354 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
51 |
51 |
$2K |
| 92015 |
Determination of refractive state |
174 |
163 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
60 |
57 |
$758.40 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
18 |
18 |
$364.32 |