| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
119 |
91 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
122 |
95 |
$2K |
| V2020 |
Frames, purchases |
134 |
105 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
62 |
51 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
17 |
15 |
$390.00 |
| V2750 |
Anti-reflective coating, per lens |
33 |
29 |
$0.00 |
| 92015 |
Determination of refractive state |
84 |
66 |
$0.00 |