| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
240 |
234 |
$7K |
| V2020 |
Frames, purchases |
433 |
390 |
$6K |
| 92015 |
Determination of refractive state |
188 |
164 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
13 |
13 |
$995.05 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
13 |
13 |
$858.73 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
65 |
64 |
$520.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
40 |
39 |
$144.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
17 |
17 |
$60.00 |