| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
59 |
59 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
67 |
67 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
89 |
88 |
$2K |
| 92015 |
Determination of refractive state |
145 |
145 |
$2K |
| V2020 |
Frames, purchases |
15 |
15 |
$386.60 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$270.79 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
14 |
14 |
$89.00 |