| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
218 |
217 |
$20K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
136 |
136 |
$10K |
| 92015 |
Determination of refractive state |
383 |
380 |
$9K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
312 |
311 |
$5K |
| V2020 |
Frames, purchases |
14 |
14 |
$700.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
14 |
14 |
$560.00 |