| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
104 |
104 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
111 |
111 |
$4K |
| V2020 |
Frames, purchases |
86 |
86 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
62 |
62 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
70 |
70 |
$1K |
| 92015 |
Determination of refractive state |
109 |
109 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
71 |
71 |
$913.06 |