| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
200 |
200 |
$9K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
56 |
55 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
17 |
17 |
$1K |
| 92015 |
Determination of refractive state |
54 |
54 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
13 |
13 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
25 |
25 |
$697.50 |
| V2020 |
Frames, purchases |
25 |
25 |
$250.00 |