| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
870 |
831 |
$16K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
131 |
121 |
$7K |
| V2020 |
Frames, purchases |
135 |
127 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
24 |
24 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
135 |
127 |
$363.13 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
52 |
52 |
$306.46 |