| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
93 |
78 |
$4K |
| V2020 |
Frames, purchases |
98 |
85 |
$2K |
| 92015 |
Determination of refractive state |
210 |
161 |
$836.31 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
23 |
14 |
$653.93 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
29 |
15 |
$275.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
41 |
39 |
$249.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
15 |
13 |
$152.30 |