| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
741 |
738 |
$4K |
| V2020 |
Frames, purchases |
727 |
727 |
$316.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
13 |
13 |
$260.00 |
| 92015 |
Determination of refractive state |
13 |
13 |
$57.20 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
610 |
312 |
$40.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
26 |
14 |
$34.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
401 |
201 |
$21.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
44 |
44 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
24 |
12 |
$0.00 |