| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
272 |
248 |
$9K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
94 |
93 |
$8K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
67 |
67 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
160 |
82 |
$6K |
| 92015 |
Determination of refractive state |
304 |
303 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$728.61 |