| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
148 |
115 |
$988.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
47 |
44 |
$595.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
86 |
57 |
$547.36 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
31 |
27 |
$460.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
14 |
14 |
$136.00 |
| 92015 |
Determination of refractive state |
90 |
60 |
$0.00 |