| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
334 |
276 |
$9K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
26 |
26 |
$2K |
| 92015 |
Determination of refractive state |
302 |
297 |
$855.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
13 |
12 |
$715.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
206 |
168 |
$634.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
207 |
169 |
$569.92 |