| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
144 |
130 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
215 |
190 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
83 |
81 |
$4K |
| V2025 |
Deluxe frame |
61 |
61 |
$658.80 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
13 |
13 |
$626.45 |
| 92015 |
Determination of refractive state |
40 |
40 |
$532.11 |