| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
266 |
265 |
$26K |
| V2020 |
Frames, purchases |
305 |
303 |
$21K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
330 |
326 |
$14K |
| 92015 |
Determination of refractive state |
644 |
638 |
$12K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
27 |
25 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
39 |
38 |
$2K |
| G9903 |
Patient screened for tobacco use and identified as a tobacco non-user |
19 |
19 |
$0.00 |