| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
60 |
60 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
29 |
29 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
28 |
28 |
$1K |
| 92015 |
Determination of refractive state |
89 |
89 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
19 |
19 |
$561.18 |
| V2020 |
Frames, purchases |
39 |
39 |
$401.76 |