| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
177 |
153 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
96 |
86 |
$4K |
| V2020 |
Frames, purchases |
28 |
27 |
$460.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
14 |
13 |
$423.54 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
14 |
13 |
$156.00 |
| 92015 |
Determination of refractive state |
13 |
12 |
$60.00 |