| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
830 |
823 |
$962.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
320 |
320 |
$104.00 |
| V2020 |
Frames, purchases |
930 |
897 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
266 |
131 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
368 |
179 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,127 |
544 |
$0.00 |