| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
526 |
525 |
$24K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
561 |
561 |
$24K |
| 92015 |
Determination of refractive state |
1,180 |
1,179 |
$17K |
| V2020 |
Frames, purchases |
253 |
253 |
$9K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
160 |
160 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
159 |
159 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
16 |
16 |
$978.70 |