| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
187 |
185 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
37 |
37 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
116 |
116 |
$2K |
| 92015 |
Determination of refractive state |
203 |
203 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
19 |
19 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
89 |
89 |
$951.15 |
| V2756 |
Eye glass case |
87 |
87 |
$23.22 |