| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
83 |
83 |
$4K |
| V2020 |
Frames, purchases |
302 |
293 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
112 |
55 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
106 |
49 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
46 |
46 |
$2K |
| 92015 |
Determination of refractive state |
123 |
123 |
$10.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
604 |
296 |
$0.00 |