| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
221 |
203 |
$19K |
| V2020 |
Frames, purchases |
415 |
380 |
$13K |
| 92015 |
Determination of refractive state |
560 |
512 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
42 |
39 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
24 |
24 |
$1K |
| V2755 |
U-v lens, per lens |
14 |
14 |
$360.19 |