| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
303 |
303 |
$6K |
| V2020 |
Frames, purchases |
343 |
330 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
177 |
177 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
214 |
206 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
38 |
37 |
$945.44 |
| 92310 |
|
12 |
12 |
$844.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
152 |
144 |
$702.00 |
| 92015 |
Determination of refractive state |
628 |
626 |
$0.00 |