| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
474 |
404 |
$22K |
| 92015 |
Determination of refractive state |
491 |
424 |
$9K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
178 |
141 |
$5K |
| V2020 |
Frames, purchases |
201 |
165 |
$675.92 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
68 |
54 |
$127.75 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
43 |
42 |
$109.31 |