| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
98 |
98 |
$6K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
142 |
139 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
120 |
119 |
$6K |
| 92015 |
Determination of refractive state |
84 |
84 |
$1K |
| V2020 |
Frames, purchases |
94 |
94 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
14 |
13 |
$415.59 |