| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
105 |
89 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
125 |
118 |
$4K |
| 92015 |
Determination of refractive state |
69 |
67 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
13 |
13 |
$585.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
13 |
$543.70 |
| 92370 |
|
84 |
82 |
$388.44 |
| V2025 |
Deluxe frame |
12 |
12 |
$131.30 |