| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
188 |
188 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
183 |
183 |
$8K |
| 92002 |
|
238 |
238 |
$7K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
161 |
156 |
$4K |
| V2025 |
Deluxe frame |
14 |
14 |
$685.01 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
26 |
26 |
$468.00 |
| 92015 |
Determination of refractive state |
212 |
211 |
$437.43 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
26 |
26 |
$0.00 |