| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
100 |
100 |
$13K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
85 |
85 |
$7K |
| V2020 |
Frames, purchases |
82 |
82 |
$6K |
| 92015 |
Determination of refractive state |
299 |
299 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
38 |
38 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$653.20 |