| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
98 |
98 |
$2K |
| 92015 |
Determination of refractive state |
200 |
198 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
34 |
33 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
62 |
62 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
17 |
17 |
$850.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
98 |
98 |
$588.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
13 |
13 |
$281.01 |