| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
169 |
169 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
145 |
145 |
$7K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
106 |
106 |
$5K |
| 92015 |
Determination of refractive state |
272 |
272 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
30 |
30 |
$899.28 |