| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
444 |
435 |
$18K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
265 |
259 |
$12K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
240 |
236 |
$5K |
| 92015 |
Determination of refractive state |
275 |
266 |
$2K |
| V2020 |
Frames, purchases |
26 |
26 |
$365.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$298.56 |
| 2026F |
|
101 |
100 |
$0.00 |
| 2033F |
|
44 |
44 |
$0.00 |