| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
303 |
302 |
$4K |
| 92015 |
Determination of refractive state |
407 |
406 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
72 |
72 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
53 |
49 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
15 |
15 |
$527.76 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
27 |
26 |
$400.00 |