| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
502 |
500 |
$22K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
522 |
514 |
$13K |
| V2020 |
Frames, purchases |
589 |
582 |
$10K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
234 |
234 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
215 |
208 |
$2K |
| 92015 |
Determination of refractive state |
856 |
854 |
$83.32 |