| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
192 |
181 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
46 |
45 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
38 |
33 |
$2K |
| 92015 |
Determination of refractive state |
267 |
239 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
42 |
39 |
$153.85 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
13 |
$60.00 |