| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
175 |
174 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
86 |
86 |
$5K |
| V2020 |
Frames, purchases |
641 |
633 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
192 |
111 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
108 |
54 |
$944.84 |
| 92250 |
|
13 |
13 |
$536.65 |