| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
370 |
370 |
$16K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
345 |
345 |
$15K |
| 92015 |
Determination of refractive state |
714 |
714 |
$14K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
72 |
72 |
$2K |
| V2020 |
Frames, purchases |
85 |
85 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
64 |
64 |
$819.00 |