| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
113 |
95 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
28 |
15 |
$275.00 |
| 92015 |
Determination of refractive state |
102 |
68 |
$240.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
19 |
12 |
$230.30 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
94 |
78 |
$92.08 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
96 |
80 |
$75.00 |