| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
400 |
391 |
$9K |
| 92015 |
Determination of refractive state |
418 |
404 |
$4K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
94 |
93 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
109 |
107 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
19 |
19 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
13 |
13 |
$945.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
25 |
13 |
$777.00 |
| V2756 |
Eye glass case |
56 |
52 |
$59.07 |