| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
465 |
456 |
$19K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
252 |
108 |
$7K |
| V2020 |
Frames, purchases |
197 |
168 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
110 |
106 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
162 |
65 |
$95.00 |
| 92015 |
Determination of refractive state |
40 |
40 |
$0.00 |