| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
329 |
326 |
$13K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
160 |
53 |
$4K |
| V2020 |
Frames, purchases |
117 |
79 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
14 |
14 |
$591.47 |
| 92015 |
Determination of refractive state |
58 |
58 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
72 |
25 |
$0.00 |