| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
122 |
114 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
18 |
17 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
99 |
94 |
$494.50 |
| V2020 |
Frames, purchases |
149 |
137 |
$312.18 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
139 |
127 |
$43.50 |
| 92015 |
Determination of refractive state |
170 |
158 |
$0.00 |