| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
134 |
117 |
$6K |
| V2020 |
Frames, purchases |
297 |
250 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
53 |
51 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
80 |
74 |
$2K |
| 92015 |
Determination of refractive state |
368 |
320 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
90 |
78 |
$919.24 |