| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
391 |
381 |
$21K |
| V2020 |
Frames, purchases |
325 |
302 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
84 |
83 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$280.72 |
| V2756 |
Eye glass case |
108 |
102 |
$115.56 |
| 92015 |
Determination of refractive state |
88 |
83 |
$0.00 |