| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
67 |
66 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
57 |
55 |
$5K |
| 92015 |
Determination of refractive state |
311 |
301 |
$4K |
| V2020 |
Frames, purchases |
27 |
26 |
$830.27 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
25 |
24 |
$802.08 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$451.48 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
12 |
12 |
$366.92 |