| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
785 |
768 |
$16K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
739 |
362 |
$15K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
187 |
187 |
$14K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
68 |
68 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,046 |
508 |
$390.00 |
| 92015 |
Determination of refractive state |
13 |
12 |
$81.04 |