| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
71 |
65 |
$2K |
| V2020 |
Frames, purchases |
141 |
138 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
71 |
71 |
$970.32 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
28 |
28 |
$558.48 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
31 |
31 |
$221.00 |
| 92015 |
Determination of refractive state |
87 |
85 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
12 |
12 |
$0.00 |