| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
308 |
308 |
$21K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
419 |
410 |
$19K |
| V2020 |
Frames, purchases |
505 |
496 |
$13K |
| 92002 |
|
87 |
86 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
84 |
84 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
67 |
67 |
$2K |
| V2756 |
Eye glass case |
225 |
222 |
$234.36 |
| 92015 |
Determination of refractive state |
31 |
31 |
$0.00 |