| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
14 |
13 |
$781.80 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
12 |
12 |
$622.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
14 |
14 |
$336.00 |
| V2020 |
Frames, purchases |
16 |
16 |
$320.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
14 |
14 |
$280.94 |
| 92015 |
Determination of refractive state |
104 |
101 |
$247.98 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
26 |
26 |
$156.00 |