| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
275 |
272 |
$12K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
406 |
405 |
$10K |
| V2020 |
Frames, purchases |
564 |
561 |
$9K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
139 |
139 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
346 |
342 |
$3K |
| 92015 |
Determination of refractive state |
529 |
524 |
$291.62 |
| V2750 |
Anti-reflective coating, per lens |
24 |
24 |
$0.00 |