| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
558 |
542 |
$24K |
| V2020 |
Frames, purchases |
81 |
79 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
73 |
70 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
12 |
12 |
$840.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
42 |
40 |
$463.71 |
| 92015 |
Determination of refractive state |
399 |
384 |
$0.00 |