| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
184 |
184 |
$24K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
106 |
106 |
$12K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
361 |
360 |
$11K |
| 92015 |
Determination of refractive state |
590 |
590 |
$10K |
| V2020 |
Frames, purchases |
361 |
360 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
31 |
31 |
$739.35 |