| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
273 |
249 |
$9K |
| 92015 |
Determination of refractive state |
315 |
284 |
$7K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
75 |
74 |
$7K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
237 |
206 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
20 |
12 |
$309.40 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
114 |
53 |
$8.50 |