| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
240 |
235 |
$10K |
| V2025 |
Deluxe frame |
91 |
86 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
122 |
120 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
16 |
16 |
$635.00 |
| 92015 |
Determination of refractive state |
491 |
480 |
$318.90 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
40 |
40 |
$185.48 |