| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
540 |
508 |
$33K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
201 |
191 |
$17K |
| V2020 |
Frames, purchases |
582 |
522 |
$13K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
327 |
296 |
$6K |
| V2756 |
Eye glass case |
551 |
497 |
$521.48 |
| 92370 |
|
33 |
31 |
$465.00 |
| 92015 |
Determination of refractive state |
14 |
12 |
$0.00 |