| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
226 |
226 |
$10K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
462 |
462 |
$9K |
| V2020 |
Frames, purchases |
643 |
637 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
473 |
469 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
627 |
621 |
$4K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
100 |
96 |
$980.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
41 |
41 |
$380.00 |
| 92015 |
Determination of refractive state |
484 |
484 |
$0.00 |