| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
190 |
187 |
$7K |
| V2020 |
Frames, purchases |
367 |
358 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
173 |
168 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
55 |
54 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
12 |
12 |
$237.50 |
| 92015 |
Determination of refractive state |
298 |
290 |
$0.00 |