| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
28 |
28 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
31 |
31 |
$3K |
| 92015 |
Determination of refractive state |
293 |
290 |
$3K |
| V2020 |
Frames, purchases |
12 |
12 |
$735.91 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$505.38 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
12 |
12 |
$0.00 |