| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
151 |
122 |
$3K |
| V2020 |
Frames, purchases |
61 |
61 |
$968.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
47 |
47 |
$920.56 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
31 |
29 |
$625.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
17 |
17 |
$88.00 |
| 92015 |
Determination of refractive state |
48 |
43 |
$0.00 |