| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
84 |
83 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
85 |
84 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
44 |
43 |
$5K |
| 92015 |
Determination of refractive state |
300 |
281 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
48 |
42 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$796.00 |