| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
181 |
177 |
$21K |
| V2020 |
Frames, purchases |
200 |
171 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
25 |
25 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
20 |
14 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
14 |
12 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
15 |
15 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
98 |
76 |
$430.00 |
| 92015 |
Determination of refractive state |
443 |
422 |
$105.00 |