| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
120 |
120 |
$6K |
| V2020 |
Frames, purchases |
181 |
181 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
225 |
113 |
$3K |
| 92015 |
Determination of refractive state |
243 |
243 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
64 |
32 |
$725.76 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$616.20 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
24 |
12 |
$272.16 |