| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
95 |
79 |
$8K |
| V2020 |
Frames, purchases |
150 |
116 |
$3K |
| V2755 |
U-v lens, per lens |
109 |
81 |
$2K |
| 92015 |
Determination of refractive state |
154 |
122 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
28 |
24 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
14 |
14 |
$1K |