| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
63 |
63 |
$3K |
| V2020 |
Frames, purchases |
72 |
70 |
$3K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
14 |
14 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
64 |
62 |
$651.62 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
18 |
17 |
$623.68 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
12 |
$423.28 |