| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
169 |
168 |
$7K |
| V2020 |
Frames, purchases |
219 |
217 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
98 |
98 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
165 |
164 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
58 |
58 |
$702.00 |
| 92015 |
Determination of refractive state |
397 |
395 |
$0.00 |