| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
168 |
168 |
$7K |
| V2020 |
Frames, purchases |
133 |
133 |
$5K |
| 92015 |
Determination of refractive state |
262 |
262 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
106 |
106 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
15 |
15 |
$600.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$146.74 |