| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
57 |
57 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
89 |
88 |
$2K |
| 92015 |
Determination of refractive state |
42 |
42 |
$827.26 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
13 |
13 |
$321.89 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
144 |
144 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$0.00 |
| V2020 |
Frames, purchases |
147 |
146 |
$0.00 |