| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
823 |
781 |
$26K |
| V2020 |
Frames, purchases |
696 |
679 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
184 |
181 |
$3K |
| 92015 |
Determination of refractive state |
99 |
97 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
34 |
34 |
$917.72 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
23 |
23 |
$20.00 |