| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
219 |
216 |
$21K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
197 |
191 |
$18K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
326 |
323 |
$8K |
| 92015 |
Determination of refractive state |
116 |
114 |
$2K |
| V2020 |
Frames, purchases |
27 |
27 |
$558.03 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
27 |
27 |
$488.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
25 |
25 |
$469.50 |