| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
79 |
79 |
$3K |
| 92015 |
Determination of refractive state |
132 |
132 |
$704.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
32 |
18 |
$320.00 |
| V2020 |
Frames, purchases |
41 |
39 |
$304.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
27 |
27 |
$216.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
40 |
40 |
$0.00 |