| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
40 |
30 |
$1K |
| V2020 |
Frames, purchases |
88 |
72 |
$1K |
| 92015 |
Determination of refractive state |
217 |
183 |
$934.70 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
16 |
12 |
$552.75 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
13 |
$289.37 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
20 |
12 |
$112.53 |