| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
305 |
303 |
$14K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
509 |
255 |
$11K |
| V2020 |
Frames, purchases |
402 |
393 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
38 |
38 |
$2K |
| 92015 |
Determination of refractive state |
155 |
154 |
$19.32 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
752 |
368 |
$0.00 |