| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
500 |
498 |
$17K |
| V2020 |
Frames, purchases |
510 |
509 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
170 |
170 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
27 |
27 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
45 |
45 |
$864.50 |
| 92015 |
Determination of refractive state |
66 |
66 |
$264.00 |