| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
81 |
81 |
$4K |
| V2020 |
Frames, purchases |
158 |
157 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
42 |
42 |
$2K |
| 92015 |
Determination of refractive state |
363 |
362 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
198 |
98 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
41 |
25 |
$299.00 |