| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
237 |
227 |
$15K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
200 |
193 |
$12K |
| V2020 |
Frames, purchases |
244 |
212 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
221 |
189 |
$160.26 |
| 92015 |
Determination of refractive state |
462 |
441 |
$45.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
222 |
190 |
$30.00 |