| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
41 |
41 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
25 |
25 |
$840.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
26 |
26 |
$646.88 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$420.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
38 |
38 |
$240.00 |
| 92015 |
Determination of refractive state |
78 |
74 |
$0.00 |