| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
856 |
851 |
$13K |
| 92250 |
|
162 |
156 |
$6K |
| 92015 |
Determination of refractive state |
725 |
722 |
$908.60 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
99 |
98 |
$879.60 |
| V2020 |
Frames, purchases |
218 |
214 |
$760.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
144 |
75 |
$47.50 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
53 |
28 |
$42.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
28 |
13 |
$0.00 |