| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
559 |
555 |
$33K |
| V2020 |
Frames, purchases |
158 |
155 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
14 |
14 |
$918.09 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
17 |
17 |
$405.34 |
| V2756 |
Eye glass case |
121 |
120 |
$124.20 |
| 92015 |
Determination of refractive state |
675 |
672 |
$0.00 |