| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
30 |
29 |
$626.25 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
87 |
83 |
$624.29 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
18 |
17 |
$591.04 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
24 |
24 |
$193.74 |
| V2756 |
Eye glass case |
30 |
29 |
$28.08 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
17 |
16 |
$0.00 |
| 92015 |
Determination of refractive state |
40 |
39 |
$0.00 |