| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
125 |
125 |
$3K |
| 92015 |
Determination of refractive state |
152 |
148 |
$395.60 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
81 |
81 |
$55.60 |
| V2020 |
Frames, purchases |
130 |
130 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
102 |
102 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
42 |
42 |
$0.00 |
| 3072F |
|
25 |
25 |
$0.00 |