| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
113 |
105 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
107 |
97 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
18 |
18 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
40 |
38 |
$368.50 |
| V2020 |
Frames, purchases |
19 |
16 |
$280.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
14 |
13 |
$233.50 |
| V2025 |
Deluxe frame |
18 |
17 |
$0.00 |