| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
236 |
236 |
$12K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
178 |
178 |
$8K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
103 |
103 |
$6K |
| V2020 |
Frames, purchases |
232 |
232 |
$5K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
12 |
12 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
13 |
$480.00 |