| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
132 |
132 |
$12K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
183 |
178 |
$12K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
190 |
188 |
$11K |
| 92015 |
Determination of refractive state |
581 |
562 |
$4K |
| V2020 |
Frames, purchases |
26 |
13 |
$97.50 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
26 |
13 |
$42.00 |
| S9999 |
Sales tax |
13 |
13 |
$25.77 |