| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
32 |
31 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
46 |
45 |
$1K |
| V2020 |
Frames, purchases |
58 |
56 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$515.52 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
14 |
14 |
$143.00 |
| V2744 |
Tint, photochromatic, per lens |
29 |
28 |
$0.00 |
| 92015 |
Determination of refractive state |
73 |
72 |
$0.00 |