| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
145 |
138 |
$19K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
111 |
97 |
$14K |
| V2020 |
Frames, purchases |
148 |
148 |
$5K |
| V2114 |
Spherocylinder, single vision, sphere over plus or minus 12.00d, per lens |
128 |
128 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
159 |
158 |
$825.00 |
| 92015 |
Determination of refractive state |
559 |
517 |
$306.44 |