| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
80 |
77 |
$1K |
| V2020 |
Frames, purchases |
145 |
145 |
$1K |
| 92002 |
|
29 |
29 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
24 |
24 |
$128.88 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
69 |
69 |
$25.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
15 |
15 |
$20.00 |
| 92015 |
Determination of refractive state |
98 |
96 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
46 |
46 |
$0.00 |