| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
27 |
24 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
17 |
15 |
$2K |
| V2020 |
Frames, purchases |
99 |
93 |
$439.83 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
120 |
111 |
$290.02 |
| 92015 |
Determination of refractive state |
159 |
148 |
$251.32 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
43 |
40 |
$0.00 |