| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
56 |
56 |
$6K |
| 92015 |
Determination of refractive state |
95 |
95 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
26 |
25 |
$748.02 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
27 |
26 |
$697.50 |
| V2020 |
Frames, purchases |
28 |
27 |
$280.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$279.00 |