| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
368 |
337 |
$846.26 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
16 |
16 |
$487.63 |
| V2025 |
Deluxe frame |
280 |
255 |
$0.00 |
| 92015 |
Determination of refractive state |
455 |
419 |
$0.00 |
| V2020 |
Frames, purchases |
384 |
336 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
227 |
206 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
260 |
233 |
$0.00 |