| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
251 |
235 |
$23K |
| 92015 |
Determination of refractive state |
1,322 |
1,181 |
$18K |
| V2020 |
Frames, purchases |
441 |
412 |
$13K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
49 |
41 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
16 |
14 |
$728.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$705.11 |