| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
320 |
320 |
$10K |
| 92015 |
Determination of refractive state |
389 |
389 |
$7K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
76 |
76 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
131 |
131 |
$4K |
| V2020 |
Frames, purchases |
266 |
266 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$334.80 |