| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
127 |
110 |
$12K |
| 92015 |
Determination of refractive state |
313 |
227 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
35 |
25 |
$2K |
| V2020 |
Frames, purchases |
30 |
24 |
$767.58 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
24 |
24 |
$638.01 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
16 |
12 |
$444.47 |