| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
298 |
234 |
$12K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
358 |
122 |
$4K |
| V2020 |
Frames, purchases |
272 |
178 |
$3K |
| 92015 |
Determination of refractive state |
595 |
436 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
19 |
12 |
$607.08 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
52 |
15 |
$301.59 |