| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
143 |
96 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
84 |
60 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
79 |
48 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
75 |
74 |
$2K |
| 92015 |
Determination of refractive state |
114 |
112 |
$2K |
| V2020 |
Frames, purchases |
27 |
14 |
$433.20 |
| V2025 |
Deluxe frame |
14 |
14 |
$151.20 |
| V2750 |
Anti-reflective coating, per lens |
28 |
15 |
$0.00 |