| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
354 |
271 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
89 |
74 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
68 |
56 |
$968.00 |
| V2020 |
Frames, purchases |
86 |
72 |
$954.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
14 |
12 |
$90.00 |
| 92015 |
Determination of refractive state |
16 |
12 |
$0.00 |