| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
349 |
349 |
$23K |
| V2020 |
Frames, purchases |
530 |
528 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
378 |
378 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
106 |
106 |
$5K |
| 92002 |
|
97 |
97 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
487 |
485 |
$1K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
23 |
23 |
$293.48 |
| 92015 |
Determination of refractive state |
412 |
412 |
$0.00 |