| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
206 |
206 |
$13K |
| V2020 |
Frames, purchases |
408 |
405 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
280 |
277 |
$7K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
84 |
84 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
141 |
140 |
$2K |
| 92015 |
Determination of refractive state |
436 |
436 |
$562.41 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
14 |
14 |
$527.80 |