| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
177 |
176 |
$16K |
| 92015 |
Determination of refractive state |
403 |
399 |
$6K |
| V2020 |
Frames, purchases |
78 |
59 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
14 |
14 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
18 |
15 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
81 |
62 |
$1K |
| V2750 |
Anti-reflective coating, per lens |
104 |
74 |
$390.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
110 |
78 |
$104.00 |