| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
246 |
243 |
$8K |
| V2020 |
Frames, purchases |
373 |
351 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
113 |
108 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
107 |
96 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
13 |
$156.00 |
| 92015 |
Determination of refractive state |
839 |
812 |
$0.00 |