| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
103 |
103 |
$4K |
| V2020 |
Frames, purchases |
164 |
147 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
66 |
50 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
26 |
26 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
38 |
38 |
$945.44 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
52 |
44 |
$750.00 |
| V2744 |
Tint, photochromatic, per lens |
13 |
13 |
$0.00 |
| 92015 |
Determination of refractive state |
63 |
63 |
$0.00 |