| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
81 |
81 |
$9K |
| 92015 |
Determination of refractive state |
231 |
231 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
152 |
151 |
$4K |
| V2020 |
Frames, purchases |
180 |
180 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
25 |
25 |
$761.37 |