| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
22 |
21 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$4K |
| V2020 |
Frames, purchases |
28 |
28 |
$3K |
| 92015 |
Determination of refractive state |
65 |
63 |
$285.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
24 |
24 |
$0.00 |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
15 |
15 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
24 |
24 |
$0.00 |