| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
69 |
45 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$1K |
| 92015 |
Determination of refractive state |
188 |
115 |
$687.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
37 |
37 |
$588.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
39 |
39 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
12 |
12 |
$0.00 |
| V2020 |
Frames, purchases |
39 |
39 |
$0.00 |