| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
144 |
144 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
77 |
77 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
14 |
14 |
$1K |
| 92250 |
|
27 |
27 |
$1K |
| V2020 |
Frames, purchases |
91 |
91 |
$910.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
28 |
28 |
$669.60 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
76 |
76 |
$0.00 |