| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
594 |
591 |
$962.40 |
| V2020 |
Frames, purchases |
198 |
197 |
$181.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
54 |
27 |
$13.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
134 |
67 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
14 |
14 |
$0.00 |
| 92015 |
Determination of refractive state |
311 |
306 |
$0.00 |