| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
399 |
397 |
$20K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
699 |
405 |
$14K |
| V2020 |
Frames, purchases |
551 |
547 |
$7K |
| 92230 |
|
68 |
68 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
109 |
108 |
$4K |
| 92015 |
Determination of refractive state |
48 |
48 |
$950.50 |
| 92250 |
|
13 |
13 |
$488.93 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
676 |
335 |
$180.00 |