| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
132 |
132 |
$13K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
175 |
174 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
132 |
132 |
$3K |
| 92015 |
Determination of refractive state |
182 |
182 |
$3K |
| V2020 |
Frames, purchases |
178 |
178 |
$2K |
| 92250 |
|
15 |
15 |
$695.70 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
183 |
183 |
$0.00 |