| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
129 |
89 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
30 |
29 |
$1K |
| 92015 |
Determination of refractive state |
102 |
101 |
$700.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
13 |
12 |
$480.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
126 |
89 |
$2.50 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
46 |
46 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
32 |
25 |
$0.00 |
| V2020 |
Frames, purchases |
142 |
101 |
$0.00 |