| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
41 |
40 |
$4K |
| V2020 |
Frames, purchases |
101 |
96 |
$3K |
| 92015 |
Determination of refractive state |
121 |
114 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
99 |
97 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
15 |
15 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
28 |
28 |
$781.44 |