| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
379 |
375 |
$23K |
| V2020 |
Frames, purchases |
433 |
430 |
$16K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
46 |
46 |
$4K |
| 92015 |
Determination of refractive state |
169 |
167 |
$895.41 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
24 |
14 |
$729.12 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
40 |
40 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
77 |
77 |
$0.00 |