| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
144 |
79 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
316 |
97 |
$3K |
| V2020 |
Frames, purchases |
156 |
95 |
$2K |
| 92015 |
Determination of refractive state |
376 |
213 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
134 |
52 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
48 |
13 |
$281.52 |