| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
176 |
170 |
$4K |
| 92015 |
Determination of refractive state |
371 |
369 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$970.59 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
13 |
13 |
$669.00 |
| V2020 |
Frames, purchases |
165 |
148 |
$97.50 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
171 |
155 |
$42.00 |