| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
402 |
400 |
$14K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
109 |
109 |
$13K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
82 |
82 |
$9K |
| 92015 |
Determination of refractive state |
434 |
430 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
162 |
161 |
$5K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
70 |
70 |
$5K |
| 92002 |
|
13 |
13 |
$899.21 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
255 |
255 |
$0.00 |