| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
92 |
90 |
$11K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
37 |
37 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
15 |
14 |
$632.58 |
| V2020 |
Frames, purchases |
15 |
14 |
$484.77 |
| 92015 |
Determination of refractive state |
834 |
793 |
$265.50 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
14 |
13 |
$175.68 |