| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
54 |
50 |
$2K |
| V2020 |
Frames, purchases |
55 |
50 |
$2K |
| 92015 |
Determination of refractive state |
134 |
129 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
45 |
45 |
$920.65 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
50 |
45 |
$638.24 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
14 |
14 |
$560.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
32 |
31 |
$404.92 |