| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
235 |
232 |
$6K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
58 |
58 |
$2K |
| 92002 |
|
19 |
18 |
$565.50 |
| V2020 |
Frames, purchases |
194 |
193 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
27 |
27 |
$0.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
15 |
14 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
12 |
12 |
$0.00 |
| V2781 |
Progressive lens, per lens |
14 |
14 |
$0.00 |