| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
191 |
191 |
$8K |
| V2020 |
Frames, purchases |
375 |
253 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
68 |
68 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
154 |
99 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
232 |
129 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
22 |
12 |
$440.00 |
| 92015 |
Determination of refractive state |
319 |
319 |
$220.77 |
| V2755 |
U-v lens, per lens |
14 |
14 |
$0.00 |