| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
341 |
328 |
$70K |
| V2020 |
Frames, purchases |
143 |
135 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
98 |
86 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
26 |
26 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
79 |
79 |
$128.69 |
| 92002 |
|
52 |
44 |
$0.00 |
| 92015 |
Determination of refractive state |
14 |
14 |
$0.00 |