| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
401 |
401 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
101 |
101 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
171 |
171 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
169 |
169 |
$2K |
| V2020 |
Frames, purchases |
170 |
170 |
$2K |
| V2760 |
Scratch resistant coating, per lens |
170 |
170 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
171 |
170 |
$346.00 |