| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
384 |
237 |
$3K |
| V2020 |
Frames, purchases |
377 |
277 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
224 |
170 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
45 |
41 |
$745.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
181 |
139 |
$472.00 |
| 92015 |
Determination of refractive state |
234 |
160 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
24 |
21 |
$0.00 |