| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
359 |
349 |
$17K |
| V2020 |
Frames, purchases |
541 |
540 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
357 |
356 |
$9K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
191 |
191 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
26 |
26 |
$790.00 |
| 92015 |
Determination of refractive state |
93 |
91 |
$0.00 |