| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
428 |
404 |
$13K |
| V2020 |
Frames, purchases |
162 |
160 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
64 |
61 |
$1K |
| 92025 |
|
125 |
122 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
101 |
93 |
$752.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
31 |
27 |
$641.82 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
12 |
12 |
$427.16 |
| 92285 |
|
139 |
133 |
$164.87 |
| 92015 |
Determination of refractive state |
466 |
457 |
$0.00 |