| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
286 |
283 |
$10K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
74 |
74 |
$4K |
| 92015 |
Determination of refractive state |
274 |
272 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
13 |
12 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
16 |
16 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
27 |
27 |
$1K |