| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
807 |
748 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
122 |
121 |
$135.00 |
| V2020 |
Frames, purchases |
176 |
170 |
$76.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
153 |
148 |
$74.64 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
172 |
167 |
$8.00 |
| 92015 |
Determination of refractive state |
16 |
14 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
70 |
70 |
$0.00 |