| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
199 |
198 |
$722.80 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
405 |
250 |
$252.00 |
| V2020 |
Frames, purchases |
382 |
370 |
$80.00 |
| 92250 |
|
213 |
211 |
$18.69 |
| V2750 |
Anti-reflective coating, per lens |
197 |
107 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
13 |
13 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
304 |
175 |
$0.00 |