| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
256 |
249 |
$16K |
| V2020 |
Frames, purchases |
515 |
515 |
$14K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
243 |
242 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
155 |
155 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
129 |
128 |
$965.00 |
| 92015 |
Determination of refractive state |
42 |
42 |
$0.00 |