| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
167 |
166 |
$19K |
| V2020 |
Frames, purchases |
314 |
314 |
$12K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
138 |
137 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
309 |
161 |
$3K |
| 92015 |
Determination of refractive state |
489 |
484 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
233 |
140 |
$1K |