| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
420 |
341 |
$12K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
89 |
83 |
$5K |
| V2020 |
Frames, purchases |
77 |
40 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
29 |
15 |
$526.32 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
13 |
13 |
$436.70 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
25 |
14 |
$150.00 |