| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
348 |
341 |
$13K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
354 |
348 |
$13K |
| V2020 |
Frames, purchases |
259 |
258 |
$7K |
| 92015 |
Determination of refractive state |
703 |
700 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
42 |
42 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
28 |
28 |
$784.00 |