| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
292 |
78 |
$996.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
274 |
62 |
$605.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
243 |
64 |
$522.48 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
186 |
56 |
$208.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
111 |
19 |
$60.00 |
| 92015 |
Determination of refractive state |
77 |
30 |
$0.00 |