| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
145 |
145 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
180 |
180 |
$3K |
| 92225 |
|
63 |
63 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
126 |
126 |
$1K |
| 92015 |
Determination of refractive state |
351 |
350 |
$510.40 |
| 92134 |
|
18 |
18 |
$348.48 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
13 |
13 |
$120.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
15 |
15 |
$0.00 |
| V2020 |
Frames, purchases |
86 |
86 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
12 |
12 |
$0.00 |