| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
269 |
261 |
$16K |
| V2020 |
Frames, purchases |
281 |
263 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$296.31 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
14 |
13 |
$242.44 |
| 92370 |
|
15 |
14 |
$195.00 |
| V2756 |
Eye glass case |
94 |
93 |
$98.28 |
| 92015 |
Determination of refractive state |
75 |
74 |
$15.05 |