| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
557 |
536 |
$9K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
116 |
112 |
$9K |
| V2020 |
Frames, purchases |
232 |
219 |
$9K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
112 |
100 |
$8K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
116 |
113 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
30 |
26 |
$669.60 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
33 |
24 |
$623.60 |
| V2756 |
Eye glass case |
31 |
30 |
$36.90 |