| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
502 |
501 |
$21K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
342 |
342 |
$15K |
| V2020 |
Frames, purchases |
883 |
878 |
$15K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
358 |
355 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
393 |
390 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
24 |
24 |
$480.00 |
| 92015 |
Determination of refractive state |
989 |
985 |
$0.00 |
| V2755 |
U-v lens, per lens |
58 |
58 |
$0.00 |