| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
198 |
198 |
$4K |
| V2020 |
Frames, purchases |
208 |
208 |
$644.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
64 |
32 |
$410.80 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
26 |
13 |
$164.32 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
13 |
13 |
$120.00 |
| V2755 |
U-v lens, per lens |
86 |
43 |
$0.00 |