| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
235 |
233 |
$10K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
263 |
260 |
$8K |
| V2020 |
Frames, purchases |
223 |
209 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
90 |
67 |
$813.76 |
| 92015 |
Determination of refractive state |
1,061 |
1,041 |
$274.57 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
21 |
18 |
$239.47 |