| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
118 |
109 |
$8K |
| 92015 |
Determination of refractive state |
407 |
391 |
$6K |
| V2020 |
Frames, purchases |
184 |
172 |
$3K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
61 |
61 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
81 |
73 |
$752.26 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$674.60 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
58 |
33 |
$436.16 |
| V2756 |
Eye glass case |
162 |
149 |
$170.84 |