| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
278 |
242 |
$16K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
250 |
213 |
$16K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
113 |
103 |
$11K |
| 92015 |
Determination of refractive state |
455 |
399 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
32 |
29 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
18 |
12 |
$2K |
| 1036F |
|
240 |
193 |
$0.00 |