| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
156 |
135 |
$7K |
| V2020 |
Frames, purchases |
360 |
296 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
101 |
76 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
142 |
123 |
$3K |
| 92015 |
Determination of refractive state |
561 |
482 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
79 |
68 |
$672.72 |