| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
271 |
212 |
$17K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
65 |
43 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
124 |
91 |
$3K |
| 92015 |
Determination of refractive state |
386 |
272 |
$2K |
| V2020 |
Frames, purchases |
263 |
172 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
72 |
37 |
$284.28 |