| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
224 |
223 |
$5K |
| 92341 |
|
148 |
144 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
101 |
83 |
$3K |
| 92015 |
Determination of refractive state |
181 |
180 |
$2K |
| V2020 |
Frames, purchases |
20 |
20 |
$900.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
14 |
14 |
$300.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
15 |
15 |
$300.00 |
| V2750 |
Anti-reflective coating, per lens |
16 |
16 |
$0.00 |