| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
35 |
31 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
26 |
25 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$308.56 |
| V2020 |
Frames, purchases |
13 |
13 |
$260.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
12 |
12 |
$258.24 |
| 92015 |
Determination of refractive state |
149 |
143 |
$247.68 |