| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
368 |
360 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
256 |
215 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
66 |
62 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
35 |
27 |
$521.16 |
| 92002 |
|
12 |
12 |
$365.00 |
| 92015 |
Determination of refractive state |
291 |
238 |
$0.00 |
| 92060 |
|
16 |
15 |
$0.00 |