| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92002 |
|
1,048 |
1,020 |
$45K |
| 92015 |
Determination of refractive state |
2,261 |
2,124 |
$36K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
836 |
765 |
$26K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
274 |
257 |
$16K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
194 |
194 |
$15K |
| V2020 |
Frames, purchases |
280 |
261 |
$12K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
64 |
64 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
158 |
147 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
50 |
42 |
$899.60 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$352.14 |
| V2756 |
Eye glass case |
270 |
251 |
$299.48 |