| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
30 |
29 |
$2K |
| V2020 |
Frames, purchases |
67 |
65 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
29 |
29 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
46 |
44 |
$984.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
17 |
17 |
$96.00 |
| 92015 |
Determination of refractive state |
126 |
124 |
$0.00 |