| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
206 |
193 |
$10K |
| V2020 |
Frames, purchases |
226 |
208 |
$4K |
| 92015 |
Determination of refractive state |
311 |
291 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
99 |
96 |
$690.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$594.70 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
14 |
14 |
$217.00 |