| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
340 |
340 |
$11K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
71 |
71 |
$9K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
27 |
27 |
$4K |
| 92015 |
Determination of refractive state |
211 |
211 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
15 |
15 |
$449.40 |
| V2020 |
Frames, purchases |
42 |
42 |
$420.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
42 |
42 |
$0.00 |