| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
539 |
531 |
$345.50 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
178 |
178 |
$50.90 |
| 92015 |
Determination of refractive state |
657 |
644 |
$34.40 |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
84 |
83 |
$0.00 |
| V2020 |
Frames, purchases |
82 |
82 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
50 |
25 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
260 |
130 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
102 |
51 |
$0.00 |