| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
178 |
173 |
$16K |
| V2020 |
Frames, purchases |
417 |
399 |
$14K |
| 92015 |
Determination of refractive state |
860 |
817 |
$11K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
30 |
30 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
57 |
57 |
$3K |
| V2755 |
U-v lens, per lens |
59 |
59 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$425.28 |