| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
277 |
246 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
266 |
263 |
$4K |
| V2020 |
Frames, purchases |
285 |
282 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
105 |
93 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
190 |
190 |
$688.00 |
| 92015 |
Determination of refractive state |
113 |
108 |
$0.00 |