| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,096 |
1,053 |
$94K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
828 |
797 |
$59K |
| S0516 |
Safety eyeglass frames |
17 |
17 |
$289.00 |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
18 |
18 |
$165.00 |
| V2020 |
Frames, purchases |
30 |
15 |
$112.50 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
32 |
16 |
$55.00 |