| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
105 |
103 |
$8K |
| V2020 |
Frames, purchases |
185 |
168 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
101 |
97 |
$4K |
| 92015 |
Determination of refractive state |
217 |
208 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
38 |
33 |
$2K |
| V2755 |
U-v lens, per lens |
60 |
59 |
$686.12 |