| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
356 |
353 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
124 |
122 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
147 |
147 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
29 |
29 |
$870.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
14 |
14 |
$631.26 |
| V2020 |
Frames, purchases |
29 |
29 |
$522.00 |