| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
855 |
854 |
$5K |
| 92015 |
Determination of refractive state |
179 |
179 |
$184.80 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
28 |
28 |
$166.80 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
146 |
71 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
24 |
12 |
$0.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
26 |
13 |
$0.00 |
| V2020 |
Frames, purchases |
364 |
358 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
108 |
54 |
$0.00 |