| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
165 |
163 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
78 |
78 |
$2K |
| V2025 |
Deluxe frame |
26 |
26 |
$1K |
| V2020 |
Frames, purchases |
33 |
33 |
$660.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$480.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
48 |
48 |
$276.31 |
| 92015 |
Determination of refractive state |
541 |
537 |
$182.07 |
| 99199 |
Unlisted special service, procedure or report |
324 |
323 |
$0.00 |