| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
381 |
376 |
$11K |
| 92015 |
Determination of refractive state |
407 |
401 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
18 |
18 |
$811.62 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
31 |
31 |
$575.92 |
| V2020 |
Frames, purchases |
86 |
86 |
$480.00 |
| 92100 |
|
27 |
19 |
$276.75 |
| 92083 |
|
20 |
15 |
$107.80 |
| 92020 |
|
27 |
19 |
$97.28 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
30 |
30 |
$24.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
20 |
20 |
$0.00 |