| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
504 |
502 |
$30K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
407 |
407 |
$24K |
| 92015 |
Determination of refractive state |
864 |
862 |
$7K |
| V2025 |
Deluxe frame |
30 |
29 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
13 |
13 |
$711.00 |
| 92310 |
|
15 |
14 |
$550.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
12 |
$258.00 |