| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
31 |
31 |
$5K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
26 |
25 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
18 |
17 |
$2K |
| V2020 |
Frames, purchases |
44 |
44 |
$2K |
| 92015 |
Determination of refractive state |
143 |
142 |
$585.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
45 |
44 |
$210.00 |
| V2755 |
U-v lens, per lens |
90 |
44 |
$0.00 |