| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
477 |
436 |
$41K |
| 92015 |
Determination of refractive state |
495 |
441 |
$6K |
| V2020 |
Frames, purchases |
166 |
166 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
125 |
125 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
57 |
57 |
$3K |
| 92250 |
|
29 |
24 |
$841.16 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
113 |
113 |
$726.91 |