| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
379 |
367 |
$26K |
| V2020 |
Frames, purchases |
375 |
372 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
206 |
102 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
59 |
59 |
$3K |
| 92250 |
|
47 |
47 |
$2K |
| V2755 |
U-v lens, per lens |
58 |
29 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
86 |
42 |
$0.00 |