| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
149 |
144 |
$12K |
| V2020 |
Frames, purchases |
338 |
327 |
$11K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
164 |
163 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
339 |
165 |
$7K |
| 92015 |
Determination of refractive state |
694 |
679 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
20 |
13 |
$607.60 |