| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
367 |
367 |
$16K |
| V2020 |
Frames, purchases |
918 |
913 |
$15K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
313 |
313 |
$13K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
607 |
603 |
$11K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
567 |
565 |
$10K |
| 92002 |
|
157 |
157 |
$7K |
| 92310 |
|
25 |
25 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
54 |
51 |
$890.00 |