| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
527 |
482 |
$12K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
130 |
122 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
42 |
42 |
$2K |
| V2020 |
Frames, purchases |
139 |
134 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
82 |
78 |
$1K |
| 92015 |
Determination of refractive state |
51 |
51 |
$627.66 |