| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
172 |
169 |
$5K |
| 92015 |
Determination of refractive state |
206 |
202 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
146 |
145 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
27 |
27 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
209 |
207 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$262.08 |