| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
202 |
175 |
$12K |
| V2020 |
Frames, purchases |
145 |
145 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
29 |
29 |
$2K |
| 92015 |
Determination of refractive state |
309 |
279 |
$88.92 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
36 |
35 |
$76.86 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
74 |
74 |
$15.00 |