| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
425 |
425 |
$18K |
| V2020 |
Frames, purchases |
859 |
857 |
$18K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
576 |
573 |
$12K |
| 92015 |
Determination of refractive state |
1,333 |
1,331 |
$11K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
47 |
46 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
26 |
26 |
$205.92 |