| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
16 |
15 |
$1K |
| 92015 |
Determination of refractive state |
61 |
60 |
$873.60 |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
12 |
12 |
$600.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
23 |
16 |
$416.00 |
| V2020 |
Frames, purchases |
15 |
15 |
$300.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
15 |
15 |
$262.92 |