| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
119 |
110 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
74 |
74 |
$3K |
| V2025 |
Deluxe frame |
87 |
81 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
82 |
75 |
$1K |
| 92015 |
Determination of refractive state |
74 |
74 |
$624.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
14 |
13 |
$455.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
12 |
$315.00 |