| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
472 |
459 |
$27K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
318 |
313 |
$22K |
| V2020 |
Frames, purchases |
268 |
137 |
$990.00 |
| 92015 |
Determination of refractive state |
424 |
419 |
$465.06 |
| S0516 |
Safety eyeglass frames |
17 |
17 |
$271.66 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
128 |
64 |
$204.00 |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
17 |
17 |
$162.32 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
30 |
15 |
$150.00 |
| S9999 |
Sales tax |
78 |
78 |
$135.78 |