| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
55 |
54 |
$5K |
| V2020 |
Frames, purchases |
28 |
28 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
40 |
40 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
28 |
28 |
$895.72 |
| 92015 |
Determination of refractive state |
46 |
45 |
$857.25 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$827.84 |