| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
155 |
151 |
$579.02 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
72 |
70 |
$354.64 |
| 92015 |
Determination of refractive state |
478 |
413 |
$0.00 |
| V2025 |
Deluxe frame |
221 |
185 |
$0.00 |
| V2020 |
Frames, purchases |
288 |
248 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
129 |
121 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
188 |
177 |
$0.00 |