| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
545 |
418 |
$35K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
344 |
278 |
$17K |
| V2025 |
Deluxe frame |
502 |
344 |
$10K |
| V2020 |
Frames, purchases |
282 |
223 |
$6K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
149 |
128 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
624 |
251 |
$5K |
| V2756 |
Eye glass case |
811 |
515 |
$496.80 |
| 1036F |
|
62 |
54 |
$0.00 |