| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
321 |
314 |
$5K |
| 92015 |
Determination of refractive state |
343 |
335 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
73 |
70 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$480.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
13 |
$252.20 |
| V2020 |
Frames, purchases |
342 |
331 |
$190.44 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
325 |
315 |
$0.00 |