| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
203 |
202 |
$13K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
73 |
72 |
$7K |
| V2020 |
Frames, purchases |
206 |
205 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
66 |
55 |
$900.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
79 |
79 |
$317.28 |
| 92015 |
Determination of refractive state |
554 |
539 |
$242.64 |
| V2755 |
U-v lens, per lens |
12 |
12 |
$165.98 |