| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
524 |
520 |
$16K |
| 92015 |
Determination of refractive state |
626 |
623 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
304 |
300 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
65 |
65 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
43 |
27 |
$311.17 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$306.86 |