| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
118 |
118 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
78 |
78 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
124 |
124 |
$3K |
| V2020 |
Frames, purchases |
148 |
148 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
74 |
74 |
$884.00 |
| 92015 |
Determination of refractive state |
227 |
227 |
$0.00 |