| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
323 |
320 |
$14K |
| V2020 |
Frames, purchases |
406 |
403 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
293 |
290 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
66 |
66 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
96 |
96 |
$1K |
| 92015 |
Determination of refractive state |
682 |
669 |
$623.14 |