| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
242 |
234 |
$18K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
118 |
113 |
$12K |
| 92015 |
Determination of refractive state |
403 |
366 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
135 |
134 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
39 |
39 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$1K |
| V2102 |
Sphere, single vision, plus or minus 7.12 to plus or minus 20.00d, per lens |
13 |
13 |
$960.96 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
12 |
12 |
$480.00 |