| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
176 |
172 |
$4K |
| 92015 |
Determination of refractive state |
95 |
94 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
58 |
55 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
54 |
53 |
$1K |
| V2020 |
Frames, purchases |
102 |
100 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
15 |
15 |
$938.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
61 |
59 |
$764.50 |