| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
73 |
71 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$664.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
117 |
116 |
$424.99 |
| V2020 |
Frames, purchases |
158 |
156 |
$99.00 |
| 92015 |
Determination of refractive state |
198 |
176 |
$55.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
70 |
56 |
$0.00 |