| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
597 |
488 |
$16K |
| 92081 |
|
533 |
448 |
$10K |
| V2020 |
Frames, purchases |
375 |
292 |
$8K |
| 92250 |
|
167 |
146 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
240 |
196 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
62 |
60 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
28 |
27 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
41 |
28 |
$779.59 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
66 |
47 |
$678.04 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
16 |
15 |
$456.30 |
| 92002 |
|
17 |
13 |
$387.30 |
| 92225 |
|
32 |
20 |
$371.40 |