| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
313 |
277 |
$2K |
| V2020 |
Frames, purchases |
824 |
719 |
$1K |
| 92015 |
Determination of refractive state |
942 |
825 |
$209.22 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
102 |
75 |
$140.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
29 |
15 |
$49.76 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
63 |
52 |
$24.00 |