| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
57 |
55 |
$2K |
| 92015 |
Determination of refractive state |
85 |
85 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
14 |
14 |
$1K |
| S0516 |
Safety eyeglass frames |
42 |
42 |
$671.16 |
| V2020 |
Frames, purchases |
145 |
68 |
$495.00 |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
42 |
42 |
$400.86 |
| S9999 |
Sales tax |
66 |
66 |
$104.16 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
20 |
15 |
$42.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
21 |
12 |
$36.00 |