| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
276 |
274 |
$13K |
| V2020 |
Frames, purchases |
161 |
159 |
$4K |
| 92015 |
Determination of refractive state |
571 |
564 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
14 |
13 |
$715.85 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$307.99 |
| V2756 |
Eye glass case |
66 |
66 |
$69.99 |