| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
537 |
533 |
$37K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
301 |
300 |
$28K |
| V2020 |
Frames, purchases |
796 |
787 |
$21K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
213 |
209 |
$5K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
28 |
28 |
$1K |
| V2756 |
Eye glass case |
97 |
96 |
$102.60 |
| 92015 |
Determination of refractive state |
1,178 |
1,172 |
$0.00 |