| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
1,075 |
964 |
$26K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
145 |
145 |
$10K |
| V2020 |
Frames, purchases |
174 |
131 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
172 |
129 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
24 |
24 |
$2K |
| 92002 |
|
15 |
15 |
$975.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
25 |
25 |
$814.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
26 |
13 |
$0.00 |