| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
710 |
690 |
$44K |
| V2020 |
Frames, purchases |
628 |
588 |
$15K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
42 |
42 |
$4K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
27 |
27 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
48 |
45 |
$806.36 |
| V2756 |
Eye glass case |
303 |
290 |
$307.68 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
16 |
15 |
$280.72 |