| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
956 |
946 |
$56K |
| V2020 |
Frames, purchases |
590 |
581 |
$15K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
342 |
336 |
$9K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
27 |
27 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
360 |
353 |
$1K |
| V2756 |
Eye glass case |
383 |
379 |
$405.00 |
| 92015 |
Determination of refractive state |
25 |
25 |
$135.45 |