| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
254 |
200 |
$18K |
| V2025 |
Deluxe frame |
171 |
117 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
76 |
57 |
$3K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
30 |
30 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
102 |
45 |
$1K |
| V2020 |
Frames, purchases |
28 |
27 |
$731.20 |
| V2756 |
Eye glass case |
423 |
310 |
$305.64 |
| 1036F |
|
66 |
62 |
$0.00 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
25 |
13 |
$0.00 |