| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
276 |
276 |
$17K |
| 92002 |
|
311 |
311 |
$13K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
135 |
135 |
$5K |
| 92015 |
Determination of refractive state |
959 |
948 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
28 |
28 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
15 |
15 |
$300.00 |
| V2020 |
Frames, purchases |
15 |
15 |
$150.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
15 |
15 |
$32.00 |