| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,515 |
1,513 |
$54K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,158 |
566 |
$20K |
| V2020 |
Frames, purchases |
1,329 |
1,298 |
$15K |
| 92015 |
Determination of refractive state |
1,383 |
1,376 |
$7K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
338 |
337 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
38 |
37 |
$906.52 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
212 |
109 |
$60.00 |
| 3072F |
|
80 |
80 |
$0.00 |