| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
272 |
260 |
$16K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
132 |
131 |
$12K |
| 92015 |
Determination of refractive state |
787 |
757 |
$11K |
| V2020 |
Frames, purchases |
93 |
89 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$345.72 |
| V2756 |
Eye glass case |
53 |
51 |
$51.84 |