| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
376 |
372 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
147 |
147 |
$560.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
196 |
195 |
$204.65 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
26 |
26 |
$74.64 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
63 |
63 |
$24.00 |
| 92015 |
Determination of refractive state |
46 |
46 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
35 |
35 |
$0.00 |