| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
105 |
105 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
31 |
28 |
$2K |
| V2020 |
Frames, purchases |
82 |
81 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
24 |
12 |
$510.24 |
| 92015 |
Determination of refractive state |
77 |
72 |
$92.89 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
89 |
44 |
$89.00 |