| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
101 |
100 |
$10K |
| V2020 |
Frames, purchases |
279 |
225 |
$8K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
89 |
86 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
106 |
104 |
$4K |
| 92015 |
Determination of refractive state |
282 |
232 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
34 |
32 |
$976.80 |