| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
94 |
94 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
34 |
34 |
$990.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
38 |
38 |
$945.44 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$360.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
12 |
12 |
$80.00 |
| 92015 |
Determination of refractive state |
222 |
222 |
$0.00 |