| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
401 |
341 |
$16K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
187 |
181 |
$12K |
| 92015 |
Determination of refractive state |
496 |
441 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
42 |
40 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
40 |
40 |
$2K |
| V2755 |
U-v lens, per lens |
12 |
12 |
$178.08 |