| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
157 |
134 |
$6K |
| V2020 |
Frames, purchases |
364 |
283 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
142 |
111 |
$5K |
| 92015 |
Determination of refractive state |
381 |
313 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
124 |
50 |
$861.12 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
79 |
67 |
$471.66 |