| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
467 |
458 |
$20K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
551 |
539 |
$20K |
| V2020 |
Frames, purchases |
340 |
338 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
274 |
273 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
158 |
158 |
$3K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
12 |
12 |
$515.52 |