| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
124 |
123 |
$3K |
| V2020 |
Frames, purchases |
347 |
344 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
81 |
81 |
$1K |
| 92015 |
Determination of refractive state |
339 |
339 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
41 |
41 |
$601.44 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
41 |
41 |
$515.52 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
162 |
160 |
$169.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
60 |
60 |
$0.00 |