| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
500 |
496 |
$25K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
416 |
416 |
$19K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
304 |
275 |
$18K |
| V2020 |
Frames, purchases |
518 |
516 |
$17K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
70 |
70 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
41 |
41 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
18 |
18 |
$0.00 |