| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
256 |
243 |
$8K |
| 92015 |
Determination of refractive state |
308 |
307 |
$7K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
99 |
99 |
$6K |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
151 |
150 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
182 |
169 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
14 |
14 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
95 |
81 |
$521.95 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
14 |
14 |
$218.40 |