| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
125 |
114 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
33 |
33 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
90 |
86 |
$1K |
| 92015 |
Determination of refractive state |
178 |
174 |
$896.98 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$624.72 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
32 |
29 |
$423.50 |