| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
50 |
50 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
47 |
47 |
$2K |
| 92015 |
Determination of refractive state |
106 |
106 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
25 |
25 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
48 |
48 |
$617.28 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
13 |
13 |
$263.12 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
17 |
17 |
$191.40 |