| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
463 |
461 |
$17K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
856 |
452 |
$14K |
| V2020 |
Frames, purchases |
642 |
636 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
121 |
121 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,007 |
510 |
$302.00 |
| 92015 |
Determination of refractive state |
609 |
608 |
$60.80 |