| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
163 |
163 |
$17K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
13 |
13 |
$395.46 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$362.70 |
| 92015 |
Determination of refractive state |
16 |
16 |
$286.24 |
| V2020 |
Frames, purchases |
13 |
13 |
$130.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
13 |
$0.00 |