| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
58 |
50 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
56 |
52 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
74 |
61 |
$616.00 |
| V2020 |
Frames, purchases |
121 |
108 |
$94.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
114 |
101 |
$0.00 |
| 92015 |
Determination of refractive state |
143 |
129 |
$0.00 |