| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
358 |
352 |
$14K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
179 |
178 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
188 |
185 |
$6K |
| V2025 |
Deluxe frame |
29 |
28 |
$1K |
| V2020 |
Frames, purchases |
59 |
59 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
127 |
124 |
$565.61 |
| 92015 |
Determination of refractive state |
669 |
660 |
$68.60 |
| 99199 |
Unlisted special service, procedure or report |
20 |
19 |
$0.00 |