| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
254 |
253 |
$11K |
| 92015 |
Determination of refractive state |
659 |
657 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
132 |
132 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
111 |
110 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
101 |
101 |
$4K |
| V2020 |
Frames, purchases |
74 |
74 |
$2K |