| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
841 |
762 |
$73K |
| V2020 |
Frames, purchases |
1,073 |
868 |
$38K |
| 92015 |
Determination of refractive state |
1,586 |
1,431 |
$19K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
80 |
74 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
33 |
26 |
$664.40 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
17 |
14 |
$241.37 |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
140 |
103 |
$0.00 |