| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
145 |
135 |
$5K |
| V2020 |
Frames, purchases |
298 |
263 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
187 |
166 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
50 |
42 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
128 |
119 |
$1K |
| 92015 |
Determination of refractive state |
479 |
417 |
$190.20 |