| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
205 |
193 |
$19K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
51 |
51 |
$4K |
| 92015 |
Determination of refractive state |
651 |
633 |
$682.12 |
| V2020 |
Frames, purchases |
12 |
12 |
$368.08 |
| 92250 |
|
49 |
48 |
$28.72 |
| V2750 |
Anti-reflective coating, per lens |
24 |
24 |
$0.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
26 |
26 |
$0.00 |
| V2755 |
U-v lens, per lens |
30 |
15 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
12 |
12 |
$0.00 |