| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
272 |
270 |
$12K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
113 |
110 |
$4K |
| V2020 |
Frames, purchases |
47 |
43 |
$528.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
28 |
26 |
$494.50 |
| 92015 |
Determination of refractive state |
56 |
53 |
$0.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
28 |
26 |
$0.00 |