| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
28 |
28 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
26 |
26 |
$1K |
| 92015 |
Determination of refractive state |
66 |
66 |
$660.00 |
| V2020 |
Frames, purchases |
22 |
21 |
$340.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
17 |
17 |
$210.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
17 |
17 |
$170.52 |