| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
146 |
146 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
247 |
130 |
$5K |
| V2020 |
Frames, purchases |
326 |
322 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$480.00 |
| 92015 |
Determination of refractive state |
282 |
282 |
$156.18 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
700 |
346 |
$0.00 |