| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
228 |
220 |
$8K |
| 92015 |
Determination of refractive state |
383 |
368 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
13 |
13 |
$595.95 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
12 |
12 |
$239.47 |
| V2020 |
Frames, purchases |
12 |
12 |
$220.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
12 |
12 |
$66.00 |