| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
668 |
667 |
$12K |
| 92015 |
Determination of refractive state |
379 |
378 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
70 |
70 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
13 |
13 |
$795.50 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
32 |
32 |
$441.00 |
| V2020 |
Frames, purchases |
32 |
32 |
$320.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
32 |
32 |
$96.00 |