| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
223 |
195 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
41 |
39 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
16 |
15 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
81 |
59 |
$1K |
| V2799 |
Vision item or service, miscellaneous |
13 |
13 |
$163.02 |
| 92015 |
Determination of refractive state |
259 |
220 |
$0.00 |