| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
241 |
241 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
104 |
104 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
189 |
189 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
40 |
40 |
$2K |
| 92015 |
Determination of refractive state |
75 |
75 |
$964.80 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
47 |
47 |
$332.00 |
| 92201 |
|
25 |
25 |
$296.40 |