| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
166 |
166 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
26 |
26 |
$2K |
| 92081 |
|
88 |
88 |
$2K |
| 92015 |
Determination of refractive state |
144 |
144 |
$2K |
| V2020 |
Frames, purchases |
41 |
41 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$882.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
12 |
12 |
$242.52 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
13 |
$151.32 |