| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
257 |
256 |
$10K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
204 |
204 |
$9K |
| 92015 |
Determination of refractive state |
399 |
399 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
167 |
167 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
28 |
28 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
62 |
62 |
$676.28 |