| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
301 |
164 |
$6K |
| V2020 |
Frames, purchases |
311 |
125 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
106 |
70 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
230 |
108 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
28 |
27 |
$953.49 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
66 |
28 |
$696.15 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
352 |
107 |
$0.00 |