| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
102 |
48 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
68 |
26 |
$4K |
| 92015 |
Determination of refractive state |
127 |
127 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
26 |
26 |
$1K |
| V2020 |
Frames, purchases |
14 |
14 |
$560.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
13 |
$167.18 |