| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
148 |
143 |
$88.15 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
39 |
37 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
41 |
40 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
16 |
16 |
$0.00 |
| V2020 |
Frames, purchases |
144 |
140 |
$0.00 |
| 92015 |
Determination of refractive state |
296 |
280 |
$0.00 |