| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
145 |
145 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
117 |
117 |
$6K |
| V2020 |
Frames, purchases |
284 |
284 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
240 |
238 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
197 |
193 |
$2K |
| 92015 |
Determination of refractive state |
324 |
324 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
41 |
41 |
$288.04 |