| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
83 |
83 |
$4K |
| V2020 |
Frames, purchases |
104 |
104 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
119 |
119 |
$2K |
| 92015 |
Determination of refractive state |
290 |
287 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$644.61 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
12 |
$169.40 |