| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
102 |
102 |
$4K |
| V2020 |
Frames, purchases |
91 |
91 |
$4K |
| 92015 |
Determination of refractive state |
189 |
189 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
27 |
27 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
42 |
42 |
$869.78 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
73 |
73 |
$829.13 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
61 |
61 |
$702.28 |