| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
271 |
266 |
$18K |
| V2020 |
Frames, purchases |
501 |
485 |
$13K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
94 |
94 |
$8K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
30 |
30 |
$1K |
| 92015 |
Determination of refractive state |
141 |
140 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
43 |
42 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
32 |
30 |
$788.74 |
| V2756 |
Eye glass case |
249 |
245 |
$261.36 |