| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
827 |
818 |
$62K |
| V2020 |
Frames, purchases |
540 |
528 |
$14K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
109 |
105 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
25 |
25 |
$498.88 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
60 |
59 |
$331.42 |
| V2756 |
Eye glass case |
306 |
300 |
$301.32 |