| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
27 |
25 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
13 |
13 |
$606.90 |
| V2020 |
Frames, purchases |
14 |
14 |
$415.55 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$274.16 |
| V2756 |
Eye glass case |
15 |
15 |
$14.04 |
| 92015 |
Determination of refractive state |
286 |
279 |
$0.00 |