| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
41 |
41 |
$3K |
| 92015 |
Determination of refractive state |
298 |
295 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$890.88 |
| V2020 |
Frames, purchases |
27 |
24 |
$551.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
12 |
12 |
$229.80 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
12 |
12 |
$192.00 |