| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
917 |
853 |
$12K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
187 |
187 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
60 |
60 |
$4K |
| V2025 |
Deluxe frame |
83 |
83 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
14 |
13 |
$997.72 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
122 |
122 |
$416.78 |