| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
177 |
115 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
14 |
14 |
$920.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$724.88 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
140 |
90 |
$136.90 |
| 92015 |
Determination of refractive state |
123 |
121 |
$115.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
155 |
100 |
$45.00 |