| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
326 |
316 |
$12K |
| V2020 |
Frames, purchases |
438 |
432 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
311 |
307 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
73 |
72 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
312 |
304 |
$3K |
| 92015 |
Determination of refractive state |
584 |
575 |
$975.69 |