| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
108 |
103 |
$8K |
| 92015 |
Determination of refractive state |
144 |
140 |
$1K |
| V2025 |
Deluxe frame |
94 |
92 |
$375.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
47 |
47 |
$170.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
20 |
20 |
$108.75 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
16 |
16 |
$22.00 |