| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
443 |
442 |
$21K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
221 |
221 |
$17K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
53 |
53 |
$5K |
| 92015 |
Determination of refractive state |
331 |
331 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
82 |
82 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$768.03 |