| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
360 |
354 |
$22K |
| V2020 |
Frames, purchases |
618 |
601 |
$16K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
108 |
103 |
$9K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
25 |
25 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
39 |
37 |
$925.14 |
| 92002 |
|
15 |
15 |
$775.80 |
| V2756 |
Eye glass case |
395 |
390 |
$409.32 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
25 |
25 |
$43.60 |